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813 - 780 -0020 City of Zephyrhills'Fire -48380 Fax -813- 780 -0021
<br /> Permit Application ..
<br /> Date Received 1 Phone Contact for Permit
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<br /> Owner's Name NO VA S ER.V1 C- E 1 NG' Owner's Phone Number p) 3 $ io ySV3
<br /> Owner's Address e. 0. box , y qG 6 YA m PA , 33677
<br /> 77
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address
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<br /> Job Address ill C.- 70 NA 11 r S 7631. GA LL B LU-17 1 Lot#
<br /> Sub Division Parcel #
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<br /> Bio- Hazard Waste Storage - ANNUAL I I Fumigation Tent
<br /> I Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> n Controlled Bum I I Hood Installation
<br /> n Emergency Generator < 30 kw • n LP /Natural Gas - Installation
<br /> I I Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> I I Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> I riyl (Semi) Fai 1 Uther
<br /> Sprinkler 0 ❑ ❑ ❑ I Recreational Bum
<br /> Fire Alarm El ❑- / ❑ ❑ I • I I I Sparklers
<br /> Hood Cleaning n a/ ❑ ❑ I I I Sprinkler System Installations
<br /> Hood Suppression CI ❑ ❑ ❑ I I I Standpipes (Sprinkler Sys) C LEAW N fJ WILL $e
<br /> I Fire Alarm Installation n Torch Roofing/Tar Kettle yo WE am Jus...y et. D 4
<br /> n Fire Pumps I ( Waste Tire Storage ANNUAL
<br /> ( Fire Works
<br /> 1 Flammable Application- ANNUAL f ( Valuation of Project
<br /> I Fuel Tanks
<br /> I Other: I I
<br /> Contractor Company tJ ©VA Se.kviCe l NG. I
<br /> Signature Registered Y / N Fee Current I Y/ N
<br /> Address I P. O. d O,Y, 4 TAmP/$, $36 I License# I
<br /> ELECTRICIAN Company I
<br /> Signature Registered Y/ N Fee Current I Y / N 1
<br /> Address I I License #
<br /> PLUMBER Company I
<br /> Signature Registered Y/ N Fee Current I Y / N I
<br /> Address I I License # I
<br /> MECHANICAL Company I
<br /> Signature Registered _ Y/ N j Fee Current I Y / N 1
<br /> Address I I License # I I
<br /> OTHER Company I
<br /> Signature Registered Y / N I Fee Current I Y / N I
<br /> Address 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 (httpi /appraiser.pascogov.com)
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