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813-780 -0020 City of Zephyrhills Fire Fax- 813-780 -0021
<br /> Permit Application _
<br /> Date Received l Phone Contact for Permit I 1
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<br /> Owner's Name V / ' s7 C'(5 ''7 I »*% ( / /(Z � Owner's Phone Number
<br /> Owner's Address tV . , j16 / `i
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address I I
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<br /> Job Address ( -- 55/b /' 7X � '1- Lot #
<br /> Sub Division Parcel #
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<br /> n Bio- Hazard Waste Storage - ANNUAL I 1 Fumigation Tent
<br /> FT Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> n Controlled Bum n Hood Installation
<br /> FT Emergency Generator < 30 kw I I LP /Natural Gas - Installation
<br /> El Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> II Fire Protection Maintenance - ANNUAL Places of Assembly- ANNUAL
<br /> F..ttrly) )semi ) FT1 Other
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ I I I I Sprinkler System Installations
<br /> Hood Suppression n ❑ ❑ ❑ I n Standpipes (Sprinkler Sys)
<br /> I - 1 Fire Alarm Installation 1 I Torch Roofing/Tar Kettle
<br /> FR nl Fire Pump
<br /> Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> I Flammable Application- ANNUAL ( ' Valuation of Project
<br /> n Fuel Tanks
<br /> Ti Other: I
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<br /> Contractor ' ^ k Company r a Signature (/ '' ' �/ I . � .
<br /> �
<br /> ��J t � � ` • _ Registered Y / N Fee Current Y / N
<br /> Address I I License #
<br /> ELECTRICIAN Company I
<br /> Signature Registered Y / N _I Fee Current 1 Y / N
<br /> Address ( I License #
<br /> PLUMBER Company I
<br /> Signature Registered Y/ N I Fee Current I Y / N
<br /> Address I I License # I
<br /> MECHANICAL Company I
<br /> Signature Registered Y / N I Fee Current I Y/ N I
<br /> Address I 1 License # I
<br /> OTHER Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N I
<br /> Address 1 License #
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<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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