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813 - 780 -0020 City of Zephyrhills Fire "z-' (0 0 ( ( Fax- 813- 780 -0021
<br /> Permit Application
<br /> Date Received 1 ej r - / a Phone Contact for Permit
<br /> Owner's Name Co n q Toi Si. ) k {r S' Owner's Phone Number Y ) 3 I ) j r I ys 7
<br /> Owner's Address - 7 ti 4 / /1 I I,/
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address
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<br /> Job Address 1 1 -I w I o A' ( 6 / k0/
<br /> Lot #
<br /> Sub Division Parcel #
<br /> ..;:at?. ,,,
<br /> Fl Bio- Hazard Waste Storage - ANNUAL I I 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
<br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> IUtrlyl ISemil Uther
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ 0 J I I I Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ I 1 n Sprinkler System Installations
<br /> Hood Suppression ❑ 17” ❑ 1 1 I Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation I Torch Roofing/Tar Kettle
<br /> n Fire Pumps I I Waste Tire Storage ANNUAL
<br /> El Fire Works
<br /> Flammable Application- ANNUAL
<br /> 1 I Valuation of Project
<br /> I[ ] Fuel Tanks
<br /> El Other: I
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<br /> Contractor - Company
<br /> Signature ' G am- Registered ( N I Fee Current 1 Y / N I
<br /> Address ( U9n pm46 n(,- /A . - - FL 7p 9 5 - 2
<br /> License #
<br /> ELECTRICIAN Company
<br /> Signature Registered Y / N I Fee Current I Y / N
<br /> Address 1 I License # I
<br /> PLUMBER Company
<br /> Signature Registered Y/ N I Fee Current I Y / N I
<br /> Address I I License #
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N I Fee Current I Y/ N I
<br /> Address I
<br /> 1 License # I I
<br /> OTHER Company
<br /> Signature Registered Y/ N j Fee Current I Y/ N
<br /> Address I
<br /> J License # I
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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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