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813- 780-0020 City of Zephyrhills Fire
<br /> Permit Application
<br /> l Fax- 813 -780 -0021
<br /> Date Received 1 2- 23-A0 Received Phone Contact for Permit
<br /> Owner's Name Ot�A �� ♦i
<br /> /i _ I 1 ,_.� .
<br /> kJ%, . �/!f Owner's Phone Number C�.
<br /> Owner's Address I 378 5- /6-t„( "gee.-
<br /> Fee Simple Titleholder Name I
<br /> Titleholder Phone Number I I I
<br /> Fee Simple Titleholder Address I
<br /> � <,� ''+gs' " ='`"�'�°;a:x � +�¢'ar,, 7"�... ,., ,'�r.��m::, gym,
<br /> Job Address 1 3 7 4 1:1 /5 E� f �,f: .h�, � ,.,,�..F;, ,c,s�� , ._� ',
<br /> /.� /eve ( Lot# I
<br /> Sub Division I Parcel #
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<br /> I Bio- Hazard Waste Storage - ANNUAL
<br /> 1 1 Fumigation Tent
<br /> Comm Exhaust Kitchen Hood /Duct I 1 Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> I Controlled Bum I I Hood Installation
<br /> I 1 Emergency Generator < 30 kw
<br /> 1 LP /Natural Gas - Installation
<br /> Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale ,
<br /> I I Fire Protection Maintenance - ANNUAL 1--1 !J"
<br /> Places of Assembly- ANNUAL
<br /> IUtrlyl (Semi !Other
<br /> Sprinkler I5Z lat ❑ ❑ Recreational Bum
<br /> Fire Alarm K I ❑ ta ❑ 1 1 I I Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ I I I I Sprinkler System Installations
<br /> Hood Suppression l ❑ ❑ ❑ f I I Standpipes (Sprinkler Sys)
<br /> Fire Alarm Installation [ ] Torch Roofing/Tar Kettle
<br /> Fire Pumps
<br /> 1 1 Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> 7 Flammable Application- ANNUAL
<br /> Fuel Tanks
<br /> I Valuation of Project
<br /> IT Other: I
<br /> ti i
<br /> .te.. .. u rya >�. .._. w ,
<br /> Contractor
<br /> Signature �4` I Compay
<br /> �� 7 Registered Y / N j Fee Current 1 Y / N
<br /> Add -
<br /> License #
<br /> ELECTRICIAN'
<br /> Signature Company
<br /> Registered Y / N j Fee Current I Y / N - I
<br /> Address I
<br /> PLUMBER
<br /> 1 License #
<br /> Signature I I Company
<br /> Registered Y / N I Fee Current I Y / N J
<br /> Address 1 I
<br /> License #
<br /> MECHANICAL I
<br /> Signature Company
<br /> Registered Y / N ] Fee Current 1 Y / N j
<br /> Address I
<br /> 1 License #
<br /> OTHER
<br /> Signature ( Company
<br /> Registered Y/ N I Fee Current I Y/ N
<br /> Address J I
<br /> t. License # I I
<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 htt //a
<br /> ( p: ppraiser.pascogov.com)
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