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7810 (80 -0020 City of Zephyrhills s Fax- 813-780 -0021 .
<br /> Permit Application
<br /> Date Received J 15 I Phone Contact for Permit 8 1 3 1%4,
<br /> 646-7
<br /> Owner's Name I Owner's Phone Number 6 (3 17g Z I /L-f(
<br /> Owner's Address
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address
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<br /> Job Address '/j74frf C�e lii : 5 6 7"L 5r 335"L( Lot#
<br /> Sub Division Parcel #
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<br /> LJ Bio- Hazard Waste Storage - ANNUAL r 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 /> El Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale i 0
<br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> ILItnyl !Semi! gal tither
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I I I I Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ I I 1 1 Sprinkler System Installations
<br /> Hood Suppression 0 ❑ ❑ ❑ I I I I Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation I I Torch Roofing/Tar Kettle
<br /> n Fire Pumps n Waste Tire Storage ANNUAL
<br /> n Fire Works
<br /> n Flammable Application- ANNUAL I +Zoo — I Valuation of Project
<br /> Ti Fuel Tanks
<br /> 11 Other: I fai 44- Ser. .15.0 Acv s r.e i err sfe--vo't e►nc -‘ I
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<br /> :�:�SiI$<4s...E_.r,:x,��.h...: 53,3? ''.e9; 1 w,.h... i$ .,., IWRE'Pdh.Stvu
<br /> Contractor c, — � -7 / Company / y'7„G -/--e-ti /,tc:_ I
<br /> Signature < i / � �a Registered Y / N I Fee Current I Y / N
<br /> Address I / p P3 4:-k )5fs g. 4cuf d U ` C •S . 574 1 6 3f I License # I
<br /> ELECTRICIAN Company I
<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
<br /> Address I I License # I I
<br /> MECHANICAL Company
<br /> Signature Registered Y / N I Fee Current I Y / N I
<br /> Address I License # I
<br /> OTHER Company
<br /> Signature Registered Y/ N J Fee Current I Y / N I
<br /> Address I License # I
<br /> Direction s:
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<br /> tions:
<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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