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313-780-0020 City of Zephyrhills Fire. Fax-813-780-0021
<br /> Permit Application
<br /> Date Received Phone Contact for Permit '2 ( f C IO' 3
<br /> Owner's Name 7._ns - ) . 0 IA el S ?v -0 Owner's Phone Number Sr") 7 -7, (/573
<br /> Owner's Address 1 4 \ C-0\ 1 1 g1 11d
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address
<br /> Job Address LC 1 113 - 3011 1 1 S o )11 tr — PA L I I C E 1 tid Lot #
<br /> Sub Division Parcel #
<br /> I I Bio-Hazard Waste Storage - ANNUAL n Fumigation Tent
<br /> ri Comm Exhaust Kitchen Hood/Duct 1 Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> I 1 Controlled Bum I I Hood Installation
<br /> 1 I Emergency Generator < 30 kw n LP/Natural Gas-Installation
<br /> El Emergency Generator > 30 kw 1----1 LP/Natural Gas-ANNUAL Sale
<br /> 1 ---- 1 Fire Protection Maintenance - ANNUAL n Places of Assembly-ANNUAL
<br /> 0
<br /> ILarly1 (Semi' pkin Other
<br /> a e , 0
<br /> Sprinkler E ID 0 0 ri Recreational Bum
<br /> Fire Alarm I 0 CI Ell I I Sparklers
<br /> Hood Cleaning 7 E ID 01 1 7 Sprinkler System Installations
<br /> Hood Suppression 2r o V ID 1 1 1 Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation I Torch Roofing/Tar Kettle
<br /> I I Fire Pumps 1 Waste Tire Storage ANNUAL
<br /> 7 Fire Works
<br /> I Flammable Application- ANNUAL I 9,9f) - - I Valuation of Project
<br /> El Fuel Tanks
<br /> I Other: I
<br /> A'• ,M: , ,.1,,:1; ,,,, • ' .-;:. ,,,, 6:,,,,k-:, , ',,,,,,,.i.a , ;T:j,',-aqMt:,-:.,.L-,. -- a:aVgn:;:m,.;:;;. , ;a;g=a'tM;9PXAQRAZ, ,,, nEP' - ' ,,,- ;' , IL' , •: 12 : , ' ,, '' .,- , ,::::::Z.a , :u .d;,,: :4.:g.:Wk.',, &Wit-MOTH' '.".L., ,:,
<br /> Contractor Company A pc t e , coas 4- r.nr
<br /> Signature ------ -- Registered gm= Fee Current Fritiran
<br /> Address I License # I
<br /> ELECTRICIAN Company I
<br /> Signature Registered Y / N Fee Current Y / N I
<br /> Address I I License # I
<br /> PLUMBER Company I
<br /> Signature Registered Y/N I Fee Current I Y/N I
<br /> Address I 1 License #
<br /> MECHANICAL Company I
<br /> Signature Registered Y / N I Fee Current I Y f N I
<br /> Address I I License # I
<br /> OTHER Company I
<br /> Signature Registered Y / N I Fee Current I Y / N 1
<br /> Address I I License # I I
<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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