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<br /> 813- 780 -0020 City ofZephyrhillsFire• Fax -813 -780 -0071
<br /> Permit Application
<br /> (n 1 `- /J 9 I - Phone Contact for Permit
<br /> ,,,,t7;,,, Received ( re z zzrr... ..,:_..,.,_,„ _,.::...,.,,r..,.,.
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<br /> Owner's l 4y e e ti ps 7 la c-- /Al ke ��c-� J Owner's Phone Number m / 3 9f 7 / 3 .
<br /> Owner's Name Gj /' "�- , o,,,:0_,.... / / ? g
<br /> Owner's Address 3 / fJ L o � �G,a /1. /N FL .. J S-
<br /> Sej Titleholder Phone Number I 1
<br /> Fee Simple Titleholder Name -
<br /> Fee Simple rttiehoider Address r „ „.
<br /> .. i i, , +. c. n f.,.: d,:. �, �- sreh�:.+ a�.; v.{`�{'.+:�.°�,..t,.2�r"'?�N'�u .a�.. ��.:w.: t,. .za.vaa'r _ •
<br /> Lot r
<br /> Job Address S a
<br /> Sub Division
<br /> 1 I Parcel # , r
<br /> J
<br /> Bio-Hazard Waste Storage - ANNUAL 71 Fumigation Tent
<br /> I Comm Exhaust Kitchen Hood /Duct 1 Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> - Controlled Bum I Hood Installation
<br /> 1 1 Emergency Generator < 30 kw I LP /Natural Gas - installation
<br /> Emergency Generator> 30 kw
<br /> LP /Natural Gas - ANNUAL Sale
<br /> I Fire Protection Maintenance - ANNUAL • I Places of Assembly- ANNUAL
<br /> 1C,ttnyi •1 semi � . � i
<br /> ` Spinkler ❑ ❑ ❑ Recreational Bum ,,11 l//t�l]Ji�U)
<br /> Are Alarm I I ❑ ❑ ❑ I 1 I Sparklers 2
<br /> i v/
<br /> Hood Cleaning n ❑ ❑ ❑ I I I Sprinkler System installations 2 4
<br /> j I Standpipes (Sprinkler Sys) 1
<br /> lJ
<br /> Hood Suppression ❑ ❑ ❑ J • Fire Alarm Installation I Torch Roofing/Tar Kettle
<br /> I I Fire Pumps 1 Waste Tire Storage ANNUAL
<br /> I I Fire Works J
<br /> I Flammable Application- ANNUAL Valuation of Project
<br /> d I Fuel Tanks
<br /> I 1 Other: 1
<br /> Contractor / Company
<br /> Signature p it& IlV Registered L Y/ N Fee Current Y / N
<br /> Address . License #
<br /> ELECTRICIAN Company
<br /> Sionature . • Registered Y / N Fee Current Y / N I
<br /> Address License #
<br /> PLUMBER Company
<br /> Signature Registered Y / N Fee Current .. Y / N
<br /> Address 1 License #
<br /> MECHANICAL Company
<br /> Signature Registered Y N f F ee Current Y/ N
<br /> Address I License #
<br /> OTHER Company
<br /> Signature Registered Y / N Fee Current I Y / N
<br /> Address 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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