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<br /> 813 -780 -0020 City of Zephyrhills Fire Fax - 813-780 -0021
<br /> Permit Application
<br /> Date Received I Phone Contact for Permit I J
<br /> ....,.,d,
<br /> Owner's Name `J. e )11(} (?j Owner's Phone Number 8I S ( 78 2 15442
<br /> Owner's Address 56 5 &ALL 1 vP
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address I I
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<br /> Job Address ( Sly SB L7 (310v Lot #
<br /> Sub Division Parcel #
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<br /> E 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 /> I - 1 Emergency Generator < 30 kw I I LP /Natural Gas - Installation
<br /> El Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> lUtrlyl (Semi JCTn Other
<br /> Sprinkler n ❑ ❑ ❑ ( ( Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ 1 1 n Sparklers
<br /> Hood Cleaning E ❑ ❑ ❑ ( I n Sprinkler System Installations
<br /> Hood Suppression n ❑ lii7 ❑ I I n Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> El Fire Pumps I I Waste Tire Storage ANNUAL
<br /> ri Fire Works
<br /> n Flammable Application- ANNUAL ( I Valuation of Project
<br /> I Fuel Tanks
<br /> El Other
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<br /> Contractor p 1 t 1 - Company
<br /> Signature Registered Y / N j Fee Current 1 Y/ N
<br /> Address I 4cg5 j " A 61 a2ADE • FL. 34210 1 License #
<br /> ELECTRICIAN Company I
<br /> Signature Registered Y/ N I Fee Current I Y / N
<br /> Address 1 I License # I
<br /> PLUMBER Company I
<br /> Signature Registered Y/ N I Fee Current I Y / N
<br /> Address I I License # I
<br /> MECHANICAL Company I
<br /> Signature Registered Y / N i Fee Current I Y / N I
<br /> Address 1 1 License # I
<br /> OTHER Company I
<br /> Signature Registered Y/ N I Fee Current l Y / N I
<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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