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813-780-0020 City of Zephyrhills Fire Fax- 813780 -0021
<br /> Permit Application
<br /> Date Received Phone Contact for Permit 1 y6 1 6 L'69' I
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<br /> Owner's Name I Owner's Phone Number I
<br /> Owner's Address
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address 1
<br /> Job Address 1 trek Aa 3 '` la..zd & 335 Z Lot#
<br /> Sub Division = / f P arcel # I
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<br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent
<br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> n Controlled Bum n Hood Installation
<br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation / \,
<br /> n n Emergency Generator> 30 kw LP /Natural Gas - ANNUAL Sale ��
<br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL 9
<br /> lUtrly) 'Semil Other
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers _. � `[ `C q
<br /> Hood Cleaning n ❑ ❑ ❑ 1 I n Sprinkler System Installations �
<br /> Hood Suppression (2) 1 X ❑ L, ❑ I 1 1 1 Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> n Fire Pumps = Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> I I Flammable Application- ANNUAL ( I Valuation of Project
<br /> El Fuel Tanks
<br /> El Other:
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<br /> Contractor Company F‘'�- ,-ir41- t / /Ke- I
<br /> Signature % % /w % P, Registered Y / N I Fee Current I Y / N
<br /> Address I Pa 4 60 Gt.-z 4 v c.„,.. 5 - 3yti 3 f I License # I
<br /> ELECTRICIAN Company I
<br /> Signature Registered Y/ N I Fee Current I Y / N
<br /> Address I License # ( I
<br /> PLUMBER Company I
<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 I Y/ N I
<br /> Address I I License # I
<br /> OTHER Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N I
<br /> Address L License #
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<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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