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813-780-0020 City of Zephyrhills Fire Fax - 813780 -0021
<br /> / Q Permit Application
<br /> Date Received 15 l Phone Contact for hone C ct fo Permit
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<br /> /( 2 Owner's Name I A B C. � 213 QQ` - �tAI.JX t Owner's Phone Number
<br /> Owner's Address
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address I I
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<br /> S lob Address Eg G 0''i . �- T\ 3 3 5 2_ Lot#
<br /> Sub Division 1 Parcel # I
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<br /> El Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent
<br /> I Comm Exhaust Kitchen Hood /Duct r--1 Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> pi Controlled Bum n Hood Installation
<br /> I1 Emergency Generator < 30 kw I LP /Natural Gas - Installation
<br /> I] Emergency Generator > 30 kw Il LP /Natural Gas - ANNUAL Sale
<br /> 1 --- ] Fire Protection Maintenance - ANNUAL II Places of Assembly- ANNUAL
<br /> 'semi 1 raj other
<br /> Sprinkler n ❑ ❑ ❑ I I Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I I I 1 Sparklers
<br /> . Hood Cleaning ❑ ❑ I 1 I—I Sprinkler System Installations
<br /> Hood Suppression I] ❑ ❑ ❑ I I [] Standpipes (Sprinkler Sys)
<br /> r Fire Alarm Installation IT Torch Roofing/Tar Kettle
<br /> I1 Fire Pumps Ii Waste Tire Storage ANNUAL
<br /> n Fire Works
<br /> n Flammable Application- ANNUAL I 1 Valuation of Project
<br /> Ii Fuel Tanks
<br /> El Other: I
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<br /> Contractor I 1 /4 Company (-I Wi \el`(', ()( L1,,, (1.. I
<br /> Signature / Registered Y/ N I Fee Current I Y / N
<br /> Address I // License #
<br /> ELECTRICIAN Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N
<br /> Address I I License #
<br /> PLUMBER Company
<br /> Signature Registered Y/ N 1 Fee Current 1 Y/ N I
<br /> Address I I License #
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N ] Fee Current I Y / N J
<br /> Address I I License # I
<br /> OTHER Company
<br /> Signature Registered Y / N 1 Fee Current I Y/ N 1
<br /> Address License # I I
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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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