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813-780-0020
<br /> City of.Zephyrhills " Fire aq '7 7 Fax- 813 - 780 -0021
<br /> Permit Application
<br /> Phone Contact for Permit
<br /> Date Received
<br /> _ .. _,...
<br /> Owner's Name A. Iii. _ l& . , 1 Owner's Phone Number ,
<br /> f�7 c j 1
<br /> Owner's Address j __V '"t -
<br /> 0 ) C�—U ` 0 r -e- -alv ') ) 2 r
<br /> Fee Simple Titleholder Name
<br /> Titleholder Phone Number ( g�_) / / 5 06 3 - 7
<br /> Fee Simple Titleholder Address
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<br /> Job A.d.d.., CZ O l 0 5
<br /> ,y. , 0 ,4. -Y -) . U c\ J� A t ' / • 4- ( 3 3 ) .1 Lot*
<br /> Job Address 1 r�'e��_' �`j/ `
<br /> Sub Division Q rr�r �.�.. .
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<br /> ' I Bio-Hazard Waste Storage - ANNUAL Fumigation Tent
<br /> I 1 Comm Exhaust Kitchen Hood /Duct I I Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> - Controlled Bum ( I Hood Installation
<br /> n Emergency Generator < 30 kw I I LP /Natural Gas - Installation
<br /> 1 Emergency Generator> 30 kw LP /Natural Gas - ANNUAL Sale
<br /> l I Fire Protection Maintenance - ANNUAL Places of Assembly- ANNUAL
<br /> 1Utrly1 lSemij J T i uther (
<br /> Sprinkler n ❑ ❑ ❑ 1
<br /> 1 Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I 1 1 I Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ I I I Sprinkler System installations
<br /> Hood Suppression n ❑ ❑ ❑ I 1 I Standpipes (Sprinkler Sys)
<br /> Fire Alarm Installation I I Torch Roofing/Tar Kettle
<br /> Fire Pumps I Waste Tire Storage ANNUAL
<br /> n Fire Works
<br /> Flammable Application- ANNUAL I I Valuation of Project
<br /> I Fuel Tanks
<br /> n Other: I
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<br /> Contractor / Company • Signature Ok-a' [ ,[ t-U\AJ 10. mil t Ar/,k._ Registered Y / N Fee Current I Y / N
<br /> Address I License* I
<br /> ELECTRICIAN Company
<br /> Signature Registered Y / N Fee Current [ Y / N
<br /> Address 1 I License # i
<br /> PLUMBER Company
<br /> Signature Registered Y / N Fee Current Y / N
<br /> Address 1 I License #
<br /> MECHANICAL Company
<br /> Signature Registered Y / N Fee Current Y / N
<br /> Address I License*
<br /> OTHER Company
<br /> Signature Registered Y/ N Fee Current I Y/ N
<br /> Address
<br /> ( License #
<br /> Directions:
<br /> Fill out application completely.
<br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner)
<br /> If over $2500, a Notice of Commencement is required. (Mechanical work over $5000)
<br /> Supply two (2) sets of drawings with applicable documentation
<br /> Allow 10 -14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com)
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