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813 -780 -0020 City of Zephyrhills Fire Fax -813- 780 -0021
<br /> Permit Application p
<br /> Date Received l Z / Z���0 Phone Contact for Permit p /3 J G��
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<br /> Owner's Name 1 /i. / J1 f/ C ,.'2.114, 4.t4Zh5 Owner's Phone Number fj(3 ~ 1 y o■
<br /> Owner's Address 3 (30 / /1',€ AM' ,ed ,535-4/0
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address I
<br /> ,:"r: .,. ..... M6ix _ .. MINIs E!ON 'n:'N,. Ott ��. Nuf 4`4s -= ,.. 1A% " � , ,n u$s 9-+ a'wr, , 'ti"$ m . y , .." : .� �.,, .... . r .�„�Mk .0a}5 ..
<br /> gym �
<br /> Job Address _c ■l_ yvx -e---- Lot #
<br /> Sub Division Parcel #
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<br /> n Bio- Hazard Waste Storage - ANNUAL I I Fumigation Tent
<br /> I I Comm Exhaust Kitchen Hood /Duct I I Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> n Controlled Bum I I Hood Installation
<br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL
<br /> l Utriy1 'Semi l Uther
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Burn
<br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ I I n Sprinkler System Installations
<br /> Hood Suppression CO •❑ ep ❑ I I I I Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation I Torch Roofing/Tar Kettle
<br /> I Fire Pumps I I Waste Tire Storage ANNUAL
<br /> 1 Fire Works
<br /> Flammable Application- ANNUAL I 2- ov I Valuation of Project
<br /> Fuel Tanks
<br /> n Other: I
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<br /> Contractor CompanyrZ .'
<br /> Signature --- ""
<br /> r - Registered Y / N Fee Current Y / N
<br /> Address I D o l l� ! 1 License # I
<br /> ELECTRICIAN Company •
<br /> Signature Registered Y / N j Fee Current 1 Y/ N I
<br /> Address I 1
<br /> License #
<br /> PLUMBER Company
<br /> Signature Registered Y / N j Fee Current I Y / N I
<br /> Address 1 I License # I
<br /> MECHANICAL Company I
<br /> Signature Registered Y / N ,I Fee Current I Y / N
<br /> Address 1
<br /> 1 License # I
<br /> OTHER Company
<br /> Signature Registered Y / N I Fee Current I Y/ N 1
<br /> Address License #
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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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