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813 - 780 -0020 City of Zephyrhills Fire Fax- 813 -780 -0021
<br /> Permit Application
<br /> Date Received j 2/ 2 Via Phone Contact for Permit 16 C(6'?
<br /> Owner's Name <6.•-a-<-_k--- -- 0 ( 6 ra iC Owner's Phone Number $r3 r 7 re7 77/ 7
<br /> Owner's Address - 7633 6A /( bl 335-4712 .
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address I y
<br /> . ,, t vz scgg t; xm 1 €tiara ,, :., •<, ..,, �. _,moo, , '',,'.. 'a , ry
<br /> Job Address Lot #
<br /> Sub Division Parcel #
<br /> <;:...ui . , ", : < I6Mi s> A4 .M s"a r, kaW4 -,' _. .--%, , ' , , :: , a.,,.,., . ,- -' ,- w , ,, .. < ... . ?w:' -', - °'>,.;;:∎ ° -t€ ?5WIZIM ,V k.'*O`:ut &.< ..,t <.. „P a . =rs V: ".
<br /> 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 n Hood Installation
<br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> I 1 Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> Ip[ 1 Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> mg Isemil (AT� Uther
<br /> Sprinkler n ❑ ❑ ❑ I Recreational Burn
<br /> Fire Alarm n ❑ ❑ ❑ l I I 1 Sparklers
<br /> Hood Cleaning I I ❑ ❑ ❑ ( 1 n Sprinkler System Installations
<br /> Hood Suppression i ❑ I' ❑ I I Standpipes (Sprinkler Sys)
<br /> I Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> Fire Pumps 1 Waste Tire Storage ANNUAL
<br /> I Fire Works
<br /> Flammable Application- ANNUAL I 2_ I Valuation of Project
<br /> I ! Ii Fuel Tanks
<br /> Other: 1
<br /> Contractor Company �c. `,�''� �^ /,01
<br /> Signature Registered Y/ N 1 F6e Curren h Y / N 1
<br /> Address PO Aix - kc , ti d 0 ( (4__C . 34' 39 1 License # I
<br /> ELECTRICIAN Company
<br /> Signature Registered Y/ N I Fee Current I Y/ N j
<br /> Address I 1 License # I
<br /> PLUMBER
<br /> Company
<br /> Signature Registered Y/ N j Fee Current I Y/ N - I
<br /> Address 1 I License # I I
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N I Fee Current I Y / N
<br /> Address I
<br /> 1 License # I
<br /> OTHER Company
<br /> Signature Registered Y/ N 1 Fee Current 1 Y / N 1
<br /> Address I 'ru I License #
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<br /> Directi � ,,x,,,a,y ;
<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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