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813-780 -0020 C ity of Zephyrhills Fir Fax- 813- 780 -0021
<br /> Permit Application
<br /> Date Received J / 1 7 a 01 I Phone Contact for Permit 1 '1 1 1 1 5 1 Q 339
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<br /> Owner's Name fie fl j) On -k j -t / c /f1 ( ( Owner's Phone Number ( f
<br /> Owner's Address 9,?,0 L11C (i: 0 (Y! /(. ki a _) LJ 6
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address I I
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<br /> Job Address 7 325 j 1 c /1 A /Vd Lot #
<br /> Sub Division Parcel # 3U D'S- z `- 0000-(1)3W0 OO 0
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<br /> 71 Bio- Hazard Waste Storage - ANNUAL 71 Fumigation Tent
<br /> riEr Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> 7 Controlled Bum n Hood Installation
<br /> I I Emergency Generator < 30 kw 1 LP /Natural Gas - Installation
<br /> 1 - 1 Emergency Generator > 30 kw 1 I LP /Natural Gas - ANNUAL Sale
<br /> 7 Fire Protection Maintenance - ANNUAL [1 Places of Assembly- ANNUAL ( \�_J
<br /> ILItrtyl !Semi' CM other
<br /> Sprinkler E ❑ ❑ ❑ n Recreational Bum Scif•-•
<br /> (JV
<br /> Fire Alarm n ❑ ❑ ❑ I n Sparklers rr 1 / , f ],
<br /> Hood Cleaning n ❑ El El ( 1 1 1 Sprinkler System Installations P (J,/
<br /> Hood Suppression Standpipes (Sprinkler Sys)
<br /> pp 17 ❑ ❑ ❑ I I 1 I
<br /> 1 �1 Fire Alarm Installation - Ti Torch Roofing/Tar Kettle
<br /> n Fire Pumps n Waste Tire Storage ANNUAL
<br /> H Fire Works
<br /> Flammable Application- ANNUAL ( \ LI (D UT I Valuation of Project
<br /> El Fuel Tanks
<br /> P 1 Other: 1 I
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<br /> Contractor Company V ; r T re ?r N c n I
<br /> Signature .1.0- L iz Registered Y / I Fee Current Y / N
<br /> Address I c� \L ( '€ - ( License# I - 3(C01 \()C)6 on
<br /> ELECTRICIAN Company I
<br /> Signature Registered Y / N 1 Fee Current 1 Y / N j
<br /> Address I I License # 1
<br /> PLUMBER Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N 1
<br /> Address 1 I License # ( I
<br /> MECHANICAL Company I
<br /> Signature Registered Y/ N Fee Current 1 Y / N 1
<br /> Address I 1 License # 1 I
<br /> OTHER Company
<br /> Signature Registered Y/ N I Fee Current I Y / N 1
<br /> Address 1 I 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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