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' 613-78o -0020 City of Zephyrhills Fire q lid Fax- 813 - 780 -0021
<br /> Permit Application
<br /> Date Received 81112 Contact fo
<br /> / ( Phone Conr Permit Lp 3 I I (tQ (0
<br /> . _ 530
<br /> Owner's Name 11i(13re-lrn. Owner's Phone Number I I I I I I
<br /> Owner's Address (04 51 c 11 ?AO. 33r1411.
<br /> Fee Simple Titleholder Name Titleholder Phone Number I 1 I
<br /> Fee Simple Titleholder Address
<br /> ,' 2u s ' ', . Ax 'r' t< ..v.' . i ,.ifs ' , a' ue, <,.,...U.a .R,. z, -;
<br /> Job Address (Awl Gall e2wd . 3354t Lot#
<br /> Sub Division Parcel # I
<br /> . , ,;, R .. , ,..,.,.: , a.x . � ... e 4o t ;'o �` . ., t . :a.e,,,mm e �x,,, awr � =,euweeozg, '. c... .. ?4- , ;% - Krei.mae ..a' .,. mw —,-mss i� :mnim .;;:._..,, , ;.... v a':. mt::,,mw:4 .,,�. mwa x y ,
<br /> ...a .,�:xe ,��.haa
<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 /> El Controlled Bum I I Hood Installation
<br /> I — I Emergency Generator < 30 kw [ 1 LP /Natural Gas - Installation
<br /> I Emergency Generator > 30 kw J 7 LP /Natural Gas - ANNUAL Sale
<br /> Fire Protection Maintenance - ANNUAL El Places of Assembly- ANNUAL
<br /> IUtrly) 'Semi' LW Uther
<br /> Sprinkler I ❑ ❑ '% l I I I Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I I Ii Sparklers
<br /> Hood Cleaning I ❑ ❑ ❑ I 1 [ ] Sprinkler System Installations
<br /> Hood Suppression ri ❑ ❑ ❑ I I I Standpipes (Sprinkler Sys)
<br /> I-I Fire Alarm Installation I-I Torch Roofing/Tar Kettle
<br /> fI Fire Pumps I Waste Tire Storage ANNUAL
<br /> n Fire Works
<br /> n Flammable Application- ANNUAL I
<br /> n Fuel Tanks I Valuation of Project
<br /> I] Other: I
<br /> Contractor I ,,------ Signature { �,�� I Company
<br /> J Registered Y/ N I Fee Current I Y/ N
<br /> Address I I License #
<br /> ELECTRICIAN! I Company
<br /> Signature
<br /> Registered Y / N I Fee Current I Y / N I
<br /> Address I I License #
<br /> PLUMBER I I Company
<br /> Signature
<br /> Registered Y/ N J Fee Current I Y / N I
<br /> Address I I
<br /> I License #
<br /> MECHANICAL'
<br /> I Company
<br /> Signature Registered Y / N J Fee Current I Y / N
<br /> Address I II
<br /> License #
<br /> OTHER I I Company
<br /> Signature Registered Y/ N 1 Fee Current I Y / N .
<br /> Address I
<br /> ....,..
<br /> License #
<br /> Directions...aM ....w _ ,__ .k•:: _r . r .., <...
<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 htt //a
<br /> ( p: ppreiser.pascogov.com)
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