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813- 780 -0020 City of Zephyrhills Fire Fax- 813-780 -0021
<br /> Permit Application
<br /> Date Received 1115 -' — i 9 1111 Phone Contact for Pe it I 1 � E m t
<br /> i
<br /> Owner's Name -t4± %''� ,11, — �c - - /OF Owner's Phone Number
<br /> Owner's Address rlsimira.:��:T_» _,
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address
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<br /> Job Address 51 30 - A ' I ` Lot #
<br /> Sub Division Parcel #
<br /> , ,, ,pM...M ,s: ARTMO . ti".Ud,.s.; ;,,• .:',.. as± • • ,,,, . . ?rk, ,_a:.: -..: ;4: -. •:s A :•X... au.... : ` °*.:d>sa«<, . :i ` HR ui" ;t`': &sd'. ' 'u
<br /> n 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 /> FT Controlled Bum n Hood Installation
<br /> El Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> n Emergency Generator> 30 kw 1 I LP /Natural Gas - ANNUAL Sale
<br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> � 1Semil tither
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ ( 1 I 1 Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ I ( n Sprinkler System Installations
<br /> Hood Suppression 6a ❑ A ❑ I I n Standpipes (Sprinkler Sys)
<br /> I Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> n Fire Pumps n Waste Tire Storage ANNUAL
<br /> El Fire Works
<br /> Flammable Application- ANNUAL I ( Valuation of Project
<br /> n Fuel Tanks
<br /> Q Other: I I
<br /> % % ac „:: a, . P. '1,'"; r" 'le""' of G E "l':A . , ' .c -° .aa.,. q. G.: u'�k ` z .. Ya1 .'��z ' „;rye .°• .�a€irlAti+'"0a`"w'�”, p ..,.. :aa,• Contractor /.4 ,
<br /> �d� ( � D _ Signature �Jr/�.G, Company Registered Y / N . 1 Fee Current I Y / N
<br /> Address I License # f
<br /> ELECTRICIAN Company
<br /> Signature Registered Y/ N 1 Fee Current 1 Y/ N
<br /> Address I I License #
<br /> PLUMBER Company
<br /> Signature Registered Y/ N I Fee Current 1 Y/ N
<br /> Address I ( License* I
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N I Fee Current I Y / N
<br /> Address 1 License #
<br /> OTHER Company
<br /> Signature Registered Y/ N J Fee Current I Y/ N
<br /> Address J License # 1
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<br /> D irections:
<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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