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813-780-0020 City of Zephyrhills'Fire Fax- 813780 -0021
<br /> ■ Permit Application
<br /> Date Received 1 Phone Contact for Permit I I
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<br /> Owner's Name � � / t / T n 1 C ` e ( l i C ke ' V Owners Phone Number
<br /> Owner's Address S"S -0 C.4 / 7 /l Uv>'
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address I
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<br /> Job Address -J 0 6 r� 1 ig / Lot #
<br /> Sub Division Parcel #
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<br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent
<br /> El Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> Controlled Bum n Hood Installation
<br /> n Emergency Generator < 30 kw I I LP /Natural Gas - Installation
<br /> 1 Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> I Fire Protection Maintenance - ANNUAL I ( Places of Assembly- ANNUAL
<br /> IUtrlyi !Semi FTC' Uther
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I 1 1 1 Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ I I I 1 Sprinkler System Installations
<br /> Hood Suppression ❑ As ❑ I I n Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation I I Torch Roofing/Tar Kettle ,
<br /> n Fire Pumps n Waste Tire Storage ANNUAL
<br /> n Fire Works
<br /> Flammable Application- ANNUAL 1 I Valuation of Project
<br /> Fuel Tanks
<br /> n Other: I I
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<br /> Contractor Company pmeiffi� ,J (' -.
<br /> Signature 41,4001 Registered Y / N Fee Current ' Y / N
<br /> Address v License # I
<br /> ELECTRICIA ' Company (
<br /> Signature Registered Y / N 1 Fee Current I Y / N I
<br /> Address ( I License # I
<br /> PLUMBER Company I
<br /> Signature Registered Y / N I Fee Current I Y / N
<br /> Address I I License #
<br /> MECHANICAL Company (
<br /> Signature Registered Y / N 1 Fee Current I Y / N I
<br /> Address I I License # I
<br /> OTHER Company
<br /> Signature Registered Y / N I Fee Current 1 Y / N I
<br /> Address 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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