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813 -780 -0020 City of Zephyrhills Fire Fax- 813-780 -0021
<br /> Permit Application
<br /> Date Received I
<br /> Phone Contact for Perm
<br /> Owner's Name G r5 ' 4 le- Cy��-V- 1/ I 1 1 Own er's Phone Number I
<br /> T
<br /> Owner's Address ,5 3 ?r-- ' /( ,C, / U C /
<br /> Fee Simple Titleholder Name Titleholder Phone Number I
<br /> Fee Simple Titleholder Address 1
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<br /> Job Address A f 'tt (. - e_- Q�,S' -e-" . .:..,
<br /> Lot #
<br /> Sub Division Parcel #
<br /> a:.;'x a, m.... .. _ z r. mmaoA A .;a,3s.msMx,wkY=r '?.:w z
<br /> z«.mwre ?` , w;., e gs. . a; . .,: Am . s..,: §, - . .0:x..:,, , ,, ; :..°,-- a ,..4,. :.: ;.
<br /> n Bao -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 I ( 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 Ti Places of Assembly- ANNUAL
<br /> �Utrlyl lsemi1 Other
<br /> Sprinkler ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I 1 1 Sparklers
<br /> Hood Cleaning r7 JQ I: ❑ I 1 n Sprinkler System Installations
<br /> Hood Suppression r ❑ ❑ ❑ 1 1 n Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> 7 Fire Pumps I 1 Waste Tire Storage ANNUAL
<br /> I I Fire Works
<br /> n Flammable Application- ANNUAL
<br /> 1 I Valuation of Project
<br /> n Fuel Tanks
<br /> n Other: I
<br /> .?-.. t le,: i._ :&::...x._ _:. ,.. ; �" ". ,'., BAMW ?, . a':' ,..tg die's` ,rte' uM .*ta} Ifiatt ; ;..;..� g'a..?.:: C, '+' ii64k �� ��
<br /> r— '.
<br /> Contractor m ny
<br /> Signature J . • 7°'in'� '✓ egistered Y / N I Current Y / N
<br /> Address 1 3'0 (S' ( A— ') °' c 0� I/` / 0. Ac — 7 - ' ✓' ) I icense #
<br /> lV
<br /> ELECTRICIAN Company
<br /> Signature Registered Y / N I Fee Current Y / N
<br /> Address I 1 License #
<br /> PLUMBER Company
<br /> Signature Registered Y / N I Fee Current I Y / N
<br /> Address I ( License # I
<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 ] Fee Current I Y / N I
<br /> Address I
<br /> 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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