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813- 780-0020 City of Zephyrhills Fire
<br /> fl (00- Fax- 813 -780 -0021
<br /> IN Permit Application
<br /> Date Received , / ,. -2X //J Phone Contact for Permit
<br /> Owner's Name 6 ji ‘—• .CT1-41e',•47' {4--[___ 7 4.4 � Owner's Phone Number I -/3 1 1 7e011 1 a, 2,6
<br /> Owner's Address 3 7 7 eil ID 4-ca 9 A -A 6 L'y '- 44- 5 �e'` IQ
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address 1
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<br /> Job Address ,3 "? 9 T g 1) k r h y p7� �
<br /> J / ) Lot #
<br /> Sub Division Parcel #
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<br /> ' I Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent
<br /> I 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
<br /> LP /Natural Gas - Installation
<br /> I I Emergency Generator > 30 kw n
<br /> LP /Natural Gas - ANNUAL Sale
<br /> Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> MO !Semis FrTI I Other
<br /> Sprinkler 7 ❑ ❑ ❑ E Recreational Bum
<br /> Fire Alarm n ❑ ❑ E l l I I Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ I I n Sprinkler System Installations
<br /> Hood Suppression n ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> n Fire Pumps n Waste Tire Storage ANNUAL
<br /> n Fire Works
<br /> n Flammable Application- ANNUAL I
<br /> Valuation of Project
<br /> Fuel Tanks
<br /> n Other: I
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<br /> Contractor
<br /> A /,,
<br /> Signature Company CD Nj Fee S _ � „ I
<br /> .. �d 7 Registered �/ N J Fee Current I YYY / N J
<br /> Address I / t o fz x f �---- Sr � - gL 31 3 1 License #
<br /> ELECTRICIAN I Company
<br /> Signature Registered Y/ N j Fee Current I Y/ N j
<br /> Address ( I License #
<br /> PLUMBER Company I
<br /> Signature Registered Y/ N j Fee Current 1 Y / N I 1
<br /> Address I License #
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N I Fee Current 1 Y / N I
<br /> Address I I License # I
<br /> OTHER Company
<br /> Signature Registered Y/ N J Fee Current 1 Y/ N I
<br /> Address ( I License # I
<br /> Directions:
<br /> s.
<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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