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813- 780 -0020 City of Zephyrhills Fire. '� ( Fax -813- 780 -0021
<br /> Permit Application
<br /> Date Received Phone Contact for Permit I , I (
<br /> Owner's Name Jo ft me W `ion) t Jot," h s:1 Ow ner's Phone Number e 1 3 7/ s
<br /> , 4S/3
<br /> Owner's Address
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address
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<br /> Job Address 7L{yf &all. ?tv/P 2efkm,:111 Fc 3 3S `1 1 Lot#
<br /> Sub Division Parcel #
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<br /> ` k , ...,,111.E iso,z... ,:1 <�" a Qa ,...:it �_. 1,... .....,. ,.r �-
<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 /> n Controlled Bum n Hood Installation
<br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> n Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale 3
<br /> n Fire Protection Maintenance - ANNUAL n -1
<br /> Places of Assembly- ANNUAL ' 9V
<br /> IUtriyl Semi] tither 1
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I I I I Sparklers
<br /> Hood Cleaning S y ❑ ❑ I I n Sprinkler System Installations
<br /> Hood Suppression n ❑ ❑ ❑ I I I Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation I I Torch Roofing/Tar Kettle
<br /> FT Fire Pumps n Waste Tire Storage ANNUAL
<br /> n Fire Works
<br /> Flammable Application- ANNUAL I ( Valuation of Project
<br /> pi Fuel Tanks
<br /> n Other: I
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<br /> Contractor Company 5,l/j9 6 1 �D fps 7 I
<br /> Y'
<br /> Signature 1) rr Registered Y / N I Fee Current I Y / N
<br /> Address 14 20 MArdox CA men; 0 1w..z L I License #
<br /> ELECTRICIAN Company I
<br /> Signature Registered Y / N I Fee Current I Y / N I
<br /> Address I
<br /> 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
<br /> Signature Registered Y / N I Fee Current I Y / N
<br /> Address I
<br /> I License #
<br /> OTHER Company I
<br /> Signature Registered Y / N I Fee Current I Y / N I
<br /> Address 1 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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