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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 1 I I 1
<br /> Owner's Name ,f e-/e //j C aiVt . b . Owner's Phone Number I g/ ; 3 7ea I go
<br /> Owner's Address ( l/ F7 7 / n5 - -- ; //s tL
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address
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<br /> Job Address Lot #
<br /> Sub Division Parcel #
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<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 /> I Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly - ANNUAL/ 7
<br /> 793,1 Semi) FT I Uther �% /0911
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum /
<br /> Fire Alarm n ❑ ❑ ❑ I I I I Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ 1 1 n Sprinkler System Installations
<br /> Hood Suppression n ❑ ❑ ❑ I 1 1 I Standpipes (Sprinkler Sys)
<br /> I - 1 Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> n Fire Pumps I I Waste Tire Storage ANNUAL
<br /> n Fire Works
<br /> H Flammable Application- ANNUAL
<br /> 1 I Valuation of Project
<br /> Fuel Tanks
<br /> I Other: I
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<br /> Contractor Company I
<br /> Signature Registered Y / N I Fee Current I Y / N I
<br /> Address I I License # I
<br /> ELECTRICIAN Company I
<br /> Signature Registered Y/ N I Fee Current I 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 I License # ( I
<br /> MECHANICAL Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N I
<br /> Address I I License # I
<br /> OTHER Company I
<br /> Signature Registered Y/ N J Fee Current I Y/ N I
<br /> Address License # 1
<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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