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813-780 -0020 City of Zephyrhills Fire `c/ q 2 31 Fax -813- 780 -0021
<br /> Permit Application l
<br /> Date Received Phone Contact for Permit f 1 /'� (�
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<br /> Owner's Name S t1.1a'Vw , 4 _ , (1 .A% Owner's Phone Number l 813 17 8 G 1 CoFY
<br /> Owner's Address 7 3L( C 3( (/d-
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address 1 I
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<br /> Job Address (0c'3 L/ �� 18I' Lot #
<br /> Sub Division ( . Parcel #
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<br /> El 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 /> I - 1 Controlled Bum n Hood Installation
<br /> I - 1 Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> F T Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> ry (J tither
<br /> ( tither
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I 1 n Sparklers Q
<br /> Hood Cleaning n ❑ ❑ ❑ 1 1 n Sprinkler System Installations - 7//, -- /O
<br /> Hood Suppression ❑ 10 ❑ I I I I Standpipes (Sprinkler Sys)
<br /> El Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> El Fire Pumps n Waste Tire Storage ANNUAL
<br /> n Fire Works
<br /> n Flammable Application- ANNUAL I Valuation of Project
<br /> n Fuel Tanks
<br /> n Other: I I
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<br /> Contractor Company
<br /> Signature Registered Y/ N I Fee Current I Y/ N I
<br /> Address I I License #
<br /> ELECTRICIAN Company
<br /> Signature Registered Y/ N j Fee Current I Y / N I
<br /> Address I I License # ( I
<br /> PLUMBER Company I
<br /> Signature Registered Y/ N J Fee Current 1 Y/ N 1
<br /> Address I I License # I I
<br /> MECHANICAL Company I
<br /> Signature Registered Y/ N 1 Fee Current I Y / N I
<br /> Address I I License # I
<br /> ■
<br /> OTHER Company 9Nre. P x,
<br /> 441 I
<br /> Signature �' I' , / Registered Y / N I Fee Current I Y / N I
<br /> Address . e9 . ' Tang ri 1.11111111111 License # • eh ' (Doi ( -
<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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