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813-780 -0020 City of Zephyrhills Fire Fax- 813-780 -0021
<br /> . Permit Application
<br /> Date Received J Phone Contact for Permit I I 1 1 I
<br /> Owner's Name T9R 'C 1 CC iZ ( Owner's Phone Number
<br /> Owner's Address iii:
<br /> 70,5^O a40
<br /> Fee Simple Titleholder Name Titleholder Phone Number 727 530 efI77
<br /> Fee Simple Titleholder Address I I
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<br /> Job Address / .6 ! d (� �4? Zf b(,i r /Ls C4 Lot #
<br /> y Parcel 1
<br /> Sub Division arcel #
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<br /> 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 FT LP /Natural Gas - Installation
<br /> I I Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> ILatrlyl ISemil Will tither
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I 1 n Sparklers
<br /> Hood Cleaning 0 ❑ ❑ ❑ I 17 Sprinkler System Installations
<br /> Hood Suppression n ❑ ❑ ❑ I 1 I I Standpipes (Sprinkler Sys)
<br /> I !' Fire Alarm Installation Ti Torch Roofing/Tar Kettle
<br /> n Fire Pumps n Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> ri Flammable Application- ANNUAL I I Valuation of Project
<br /> n Fuel Tanks
<br /> 7 Other: I
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<br /> Contractor Company
<br /> Signature f/y✓) Registered Y/ N I Fee Current I Y/ N
<br /> •
<br /> Address I I 4 License # I
<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 I I License # I I
<br /> MECHANICAL Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N I
<br /> Address I 1 License # I I
<br /> OTHER Company I
<br /> Signature Registered Y/ N I Fee Current I Y / N
<br /> Address J 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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