|
8'I&- q,) -0020 City of Zephyrhills Fire. q2%,Q Fax -813- 780 -0021
<br /> •
<br /> • Permit Application __
<br /> Date Received I 1 Phone Contact for Permit 1 1 I 1 I
<br /> .._r.. _� pP e. �..• /
<br /> Owner's Name Ci � vT ZePAlrib Its J Owner's Phone Number
<br /> �
<br /> Owner's Address 5 3 3J 'Th St , Z ' ,Ayr 11's l 1- 33 � / Z
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address I I
<br /> ,, .,.,; s* ,..,,:•;; < s_. ,....1 . 1 .'gs" z.P ; . r: ISi. 4 Stla:, , , ✓ ° W,' a r„ ' - �.i = *WINVWfaaPaWK >x'a �`PFT 3 ..,r. 1,11. ". ZF .:'a ..,w.e.l ,,` .ARM to
<br /> Job Address 373° ( Ch cope 1 It 1 L•oa p , Z f y r Jl As Lot #
<br /> Sub Division Parcel / # 03 - 02(0 ° 21 0 6/0- / V o Xia -C.)010
<br /> Ear. +:sr:..., ,. eA`.°, : I'Zi,'F r , . aPR,ttWnrak • .' AW4M ZVEW PAMME':..�:�;§:, .. »::.3,� WTZa - :: rv1.w`° ..3 � 1 f' a'"+:,'�ws .'Y�. a .'�5.rad, .� .... ?, .Nq,:514S k F;�i , .O.._ .' a `+
<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 Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale
<br /> ® Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> IUtrlyl ISemiI ra1 Other
<br /> Sprinkler ❑ ❑ lOr I I Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I 1 n Sparklers
<br /> Hood Cleaning 0 ❑ ❑ ❑ I I n Sprinkler System Installations
<br /> Hood Suppression IT ❑ ❑ ❑ 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 /> I I Fire Works
<br /> Flammable Application- ANNUAL I 1 Valuation of Project
<br /> Fuel Tanks
<br /> n Other I
<br /> .... : : > 2 FM as&.' «a lft....=ar. 'MEM .., ,, is ...eMi:. ..s .r`. .•a+ all ?ZA :, ..,..?Sgegtf _ an . & eiF...> ' . a:::;r...., '' Mg3.a"Ze •... E:1E`c54M..'€ C €i.
<br /> Contractor / Company ' i( lF ' �� _i
<br /> Signature -- Registered ge� Fee Current
<br /> Address '7 • , i.. / 41. u L License # 119.<$ / 76/000 // '/2•
<br /> ELECTRICIAN Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N
<br /> Address I I License # I
<br /> PLUMBER Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N I
<br /> Address 1
<br /> 1 License # I I
<br /> MECHANICAL Company I
<br /> Signature Registered Y / N I Fee Current I Y / N I
<br /> Address ( I License # I
<br /> OTHER Company I
<br /> Signature ' ,031111/4 o, Registered Y / N 1 Fee Current I Y / N I
<br /> Addres�, J g �i License #
<br /> Dir it - ..•r: •:, . "�F:. � � ,a„
<br /> er '
<br /> • Fi • -: , corfbletely.
<br /> 1 � r ,,.= ctor siet back of application, notarized (Or, copy of signed contract with owner)
<br /> tf ove i, a hlotice•of Commencement is required (Mechanical work over $5000)
<br /> : Suppl 2) sets of- rawings with applicable documentation
<br /> Ilbyv 10 -14 day f oraview after submittal date. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com)
<br /> 111 N
<br />
|