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813-780 -0020 City of Zephyrhills-Fire, Fax - 813-780 -0021
<br /> Permit Application _.
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<br /> / Phone Contact for Permit I 4 6 1- 1 /5 4 a, I S 6,
<br /> Date Received _.,..�,��� , ;�..� � < • �.w � ,. - .,�....
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<br /> Owner's Name blest N5 Le (0.4 i Tr -t' Owner's Phone Number 'g 1 7 "bs ' 5
<br /> Owners Address E q a h 1j r •
<br /> Fee Simple Titleholder Name Titleholder Phone Number ,
<br /> Fee Simple Titleholder Address I I
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<br /> Job Address 16 ra, t 1JteJSf N 5 4- a4e1- L•�,, -•316 e�_.. .7. '-.: Lot#
<br /> Sub Division Parcel # 03 y p-( `2 6 0 14 - 4000I '
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<br /> I Bio- Hazard Waste Storage — ANNUAL n Fumigation Tent
<br /> n h Comm Exhaust Kitchen Hood /Duct Hazardous Material (Tier II or RQ,Facllity) ANNUAL
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<br /> Controlled Bum Hood Installation :
<br /> n � �� Emergency Generator < 30 kw I I LP /Natural Gas - Install ion / (/
<br /> n Emergency Generator > 30 kw I I LP /Natural Gas -ANN Sale
<br /> Fire Protection Maintenance - ANNUAL I ( Places of Assembly - ANNUAL II1 �)
<br /> Iutrly( ISemiI raj @�i1L3i / 4L "
<br /> Sprinkler ❑ ❑ I I Recreational Bum e f1 ) '
<br /> Fire Alarm 7 ❑ ❑ I 1 1 I Sparklers / /
<br /> Hood Cleaning n ❑ ❑ ❑ 1 1 1 1 Sprinkler System Installations
<br /> Hood Suppression n ❑ ❑ ❑ 1 1 I Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation 1 1 Torch Roofing/Tar Kettle
<br /> n Fire Pumps I ^I Waste Tire Storage ANNUAL
<br /> I I Fire Works
<br /> Flammable Application- ANNUAL 1 , Valuation of Project
<br /> Fuel Tanks
<br /> Other: _
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<br /> Contractor ^ Company A.-A -/4- ��F �Q C 74S Ve
<br /> Signature (/ V / V t Registered Y / N 1 Fee Current Yu/ N
<br /> Add ess - 5 0 v_- 6 ix 0 rs.ie2>E o 64 . `rp4 7 1 License # I IS 4 1)'% a7 u o o e► =t) 4
<br /> ELECTRIC • N Company I
<br /> Signature Registered Y/ N I Fee Current [ Y/ N 1
<br /> Address I I License #
<br /> PLUMBER Company I
<br /> Signature Registered Y/ N 1 Fee Current 1 Y / N 1
<br /> Address I I License # I
<br /> MECHANICAL Company I
<br /> Signature Registered Y / N 1 Fee Current I Y / N
<br /> Address I I License #
<br /> OTHER CF "
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<br /> r //�,(, + Company Ir �L; Zi
<br /> Signatur= Registered Y / N Fee Current Y / N
<br /> Ad ress ', / 0 0 ‘5$2- ,, • , , /i - / License # I •1$ $ ,. c3 60 / aOV 7
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<br /> Direction •
<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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