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<br /> 813 -780 -0020
<br /> City of Zephyrhills Fire Fax-813-780-0021
<br /> Permit Application
<br /> Date Received a- 0 ?3 / 6 Phone Contact for Permit
<br /> 6, /2
<br /> � / /
<br /> (�/'l m
<br /> Owner's Name " ,' n - T L r t_ e 'C Z / ,4 r (/S Owner's Phone Number 15 /1 j € I 1
<br /> Owner's Address S- <1 . ±- SA
<br /> Fee Simple Titleholder Name Titleholder Phone Number I
<br /> Fee Simple Titleholder Address 1
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<br /> Job Address I/ L G e n LC +1 f 'l -7 t ✓1 - - 1..% / �Q
<br /> / Jat) -...p Le., 7 Lot#
<br /> Sub Division Parcel #
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<br /> Bio- Hazard Waste Storage - ANNUAL Fumigation Tent
<br /> I Comm Exhaust Kitchen Hood /Duct Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> I Controlled Bum Hood Installation
<br /> I Emergency Generator < 30 kw LP /Natural Gas - Installation
<br /> I Emergency Generator > 30 kw LP /Natural Gas - ANNUAL Sale
<br /> I -- 1 Fire Protection Maintenance - ANNUAL Places of Assembly- ANNUAL
<br /> IQtrlyl'SemiI Fri Uther
<br /> Sprinkler (—( ❑ ❑ ❑ m Recreational Bum
<br /> Fire Alarm (—( ❑ ❑ ❑ I ( 111111111 Sparklers
<br /> Hood Cleaning 7 ❑ ❑ ❑ 1 1 I I Sprinkler System Installations
<br /> Hood Suppression I ❑ ❑ ❑ I I Standpipes (Sprinkler Sys)
<br /> I Fire Alarm Installation IT Torch Roofing/Tar Kettle
<br /> n Fire Pumps I 1 Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> Flammable Application- ANNUAL I ( Valuation of Project
<br /> Fuel Tanks
<br /> El Other: I
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<br /> Contractor / /1 Company
<br /> Signature l J j� Q/)(Q /.4.) f) k n Registered Y / N I Fee Current Y / N
<br /> Addre i -- Pt 01 f "' ` "r// "' I License # I
<br /> I
<br /> ELECTRICIAN
<br /> Company
<br /> Signature Registered Y / N I Fee Current I Y / N j
<br /> Address I
<br /> I License # I
<br /> PLUMBER Company
<br /> Signature Registered Y/ N Fee Current I Y/ N
<br /> Address I
<br /> I License*
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N Fee Current I Y/ N j
<br /> Address 1 I
<br /> License #
<br /> OTHER
<br /> Company
<br /> Signature Registered Y/ N I Fee Current 1 Y/ N j
<br /> Address J I License #
<br /> Directions: Imo:,E
<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 # - obt l3 dfrnp�.8,rpoertlt�ax.Nol a - lttig D i
<br /> BYZ ILLS FIRE MARSHAL'S OFFICE
<br /> Date: - 30 I IC)
<br /> Reviewer:
<br />
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