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<br /> 813-780-0020 City of Zephyrhills Fire yJ! 9 7-4-
<br /> % ` Fax- 813 -780 -0021
<br /> Permit Application
<br /> Date Received Phone Contact for Permit
<br /> aOwner's Name M'4 ,1! I .-.. ,•Im tit A y t a > %e Owner's Phone Number I $t7 / 113 7"7 1 1 / . (9 1
<br /> Owner's Address 1 3 1 52 5l ` z e� ><y r-14 r` l5 i rt 3 3 S T �-
<br /> ' Fee Simple Titleholder Name I 1 Titleholder Phone Number 1 p / 1377 113 8 3
<br /> Fee Simple Titleholder Address I I
<br /> � . ` / ✓evV.
<br /> Job Address °l I '3
<br /> 7 9 I 1 5P '5 `1 Ze,. y 4i (5, f/ Lot #
<br /> Sub Division I I Parcel # I I
<br /> '.' N"'$,.. ? ", <e..:.in#46.i"ra +a Pn 3: 5d.`.'+ ;3F•,$m'F•`. ->'.s .`*s;..,::3'.. ,.,,_ >.°.$ n: A& ^;,>.�ux4'22`aa.3.,a_:::,' r3 ..v.,;:: ...ask*xxx. Tai( „/.d9 nab` L' i' u'. x1. R"f` wwn% '✓k#'da�_Sv':�k'x"R"fdsXi:mgr.k iNt:t#,Fd ..�.ar:>.. �'.`.a`r es^a -�.f'
<br /> Il Bio-Hazard Waste Storage - ANNUAL = Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> El Comm Exhaust Kitchen Hood /Duct El Hood Installation
<br /> El Controlled Bum = LP /Natural Gas - Installation
<br /> Emergency Generator < 30 kw E=I LP /Natural Gas - ANNUAL Sale
<br /> Emergency Generator > 30 kw I-1 Places of Assembly- ANNUAL
<br /> El Fire Protection Maintenance - ANNUAL n Recreational Bum
<br /> [jjj'j Elaill (y11 tit)` 7 '
<br /> Sprinkler D ❑ ❑ ❑ 'Other E Sparklers Et
<br /> Fire Alarm El ❑ ❑ ❑ I I E Sprinkler System Installations Z, , / / 1 i 1
<br /> Hood Cleaning El ❑ ❑ ❑ I I = Standpipes (Sprinkler Sys) t5 3 —
<br /> Hood Suppression 0 ❑ ❑ ❑ I I El Tor oofmgfiarKettle 1 „ .1 L gfh 4/4-
<br /> El Fire Alarm Installation T
<br /> I I 1 Tire Storage ANNUAL - ek i � L,
<br /> -- 6I l Y�
<br /> Q
<br /> Fire Pumps
<br /> Fire Works
<br /> Flammable Application- ANNUAL I I Valuation of Project
<br /> Fuel Tanks
<br /> n Other: I
<br /> W tV. ,': . Ar"::. * .'1 ? S "•SfYe,' 'r',:, °. :'e "£Y b ' • ' im"s^,?:,) ,,,, "W'''' , �"'',' '°'' ''' '' `' „4 1. .. .
<br /> ter. Z. .. x .... A . . .. M
<br /> Contractor r '/ Company
<br /> r Signature e - 8 , 1 i, ( r= -..- Registered Y / N J Fee Current I Y / N I
<br /> Address ( I License # I
<br /> ELECTRICIAN Company
<br /> Signature Registered Y/ N I Fee Current I Y / N I
<br /> Address I I License # I
<br /> PLUMBER Company
<br /> Signature Registered Y/ N I Fee Current I Y / N I
<br /> Address I I License # I I
<br /> MECHANICAL Company I
<br /> Signature Registered Y/ N I Fee Current 1 Y/ N J
<br /> Address I I License # I I
<br /> OTHER Company
<br /> Signature Registered Y/ N I Fee Current I Y/ N I
<br /> Address License #
<br /> , a�,r- sr: >:>x. xk..� .... z.:.>.. �;» :....;•a,:.»a;';.';•,.....:...: PK.. ..< •.::-. a:s.:;cs. s ,�,stu,w,....s,,A....,. ..•�,:xir:;A,.w�..�:
<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 - days for review after submittal date. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com)
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