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<br /> 813-780-0020 City of Zephyrhills Fire Fax-813-780-0021
<br /> Permit Application
<br /> Date Received j Phone Contact for Permit 18 1,3 1 17 itr ,..) 1 Flu 1
<br /> Owner's Name lit KO' CA . ea of C h i ■ i r. SO v ' .1 0 1 .1 . k t 1 1 Owner's Phone Number E /3 17 8 .)-- ,ac 54
<br /> Owner's Address 3 cro 3 4/..40( al.‘- - 7, Lil, 3 3 J
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address
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<br /> Job Address ? d' %S.-1/ 3 -4 1.... 14 Arl-c„. 2 49-, 144 - .? 3 -0 .1 Lot #
<br /> Sub Division Parcel #
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<br /> n Bio-Hazard Waste Storage - ANNUAL F Fumigation Tent
<br /> 1 Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> Pi Controlled Bum r---1 Hood Installation
<br /> n Emergency Generator < 30 kw r--1 LP/Natural Gas-Installation
<br /> r---1 Emergency Generator > 30 kw I LP/Natural Gas-ANNUAL Sale
<br /> ni Fire Protection Maintenance - ANNUAL X Places of Assembly-ANNUAL
<br /> rCIfFryl 'Semi] ragi Other
<br /> Sprinkler TIE O 0 1 Recreational Bum
<br /> Fire Alarm 7 0 0 0 1 ( n Sparklers
<br /> Hood Cleaning 7 0 0 0 1 I 1 Sprinkler System Installations
<br /> Hood Suppression 1 ID I: 1 ( 1 I Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation F Torch Roofing/Tar Kettle
<br /> i---1 Fire Pumps ri Waste Tire Storage ANNUAL
<br /> n Fire Works
<br /> I I Flammable Application- ANNUAL
<br /> 1 I Valuation of Project
<br /> 1 - 1 Fuel Tanks
<br /> n Other: 1
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<br /> Contractor Company
<br /> Signature ceic/144...,,t,,ZA,A,4-...."..7:6,...t.../ Registered Y / N J Fee Current I Y / N I
<br /> Address I 3 ALA -- i . 2 ‘ , / , ,,, , ( . I License #
<br /> ELECTRICIAN Company
<br /> Signature Registered Y / N 1 Fee Current I Y / N j
<br /> Address License #
<br /> I
<br /> PLUMBER Company
<br /> Signature
<br /> Registered Y/N ] Fee Current I Y/N 1
<br /> Address I
<br /> I License #
<br /> MECHANICAL
<br /> Company
<br /> Signature
<br /> Registered Y/N I Fee Current I Y/N j
<br /> Address I
<br /> 1 License #
<br /> OTHER
<br /> Company
<br /> Signature
<br /> Registered Y / N 1 Fee Current I Y / N I
<br /> Address j
<br /> j License #
<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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