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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 I
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<br /> Owner's Name 17 ./?' #UN L(-- >3 r f Owner's Phone Number
<br /> Owner's Address V- .--
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<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address
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<br /> Job Address � `3 /s --6/ /I �L �,- �S Lvv �"U:I 1(5 3381{ 2 Lot #
<br /> Sub Division Parcel #
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<br /> 1 - 7 Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent
<br /> n Comm Exhaust Kitchen Hood /Duct I I Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> FT Controlled Bum n Hood Installation
<br /> El Emergency Generator < 30 kw I I LP /Natural Gas - Installation
<br /> n Emergency Generator> 30 kw LP /Natural Gas - ANNUAL Sale
<br /> n Fire Protection Maintenance - ANNUAL Places of Assembly- ANNUAL
<br /> 'Carly' (Semi) Other
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm E ❑ ❑ ❑ I I n Sparklers
<br /> Hood Cleaning E ❑ ❑ ❑ I I n Sprinkler System Installations
<br /> Hood Suppression E ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys)
<br /> T1 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 Valuation of Project
<br /> n Fuel Tanks
<br /> El Other: I I
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<br /> Contractor 9 � Company
<br /> •
<br /> Signature n
<br /> . J L S ',, rf
<br /> < � _, C � Registered Y / N 1 Fee Current I Y / N
<br /> Address C License #
<br /> I
<br /> ELECTRICIAN Company
<br /> Signature Registered Y / N I Fee Current I Y / N I
<br /> Address I I License #
<br /> PLUMBER Company
<br /> Signature Registered Y / N j Fee Current I Y / N I
<br /> Address I
<br /> I License #
<br /> MECHANICAL Company
<br /> Signature Registered Y / N I Fee Current 1 Y / N 1
<br /> Address I
<br /> I License #
<br /> OTHER Company
<br /> Signature Registered Y / N J Fee Current I Y / N I
<br /> Address I
<br /> 1 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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