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813-780 -0020, City of.Zephyrhills Fire, 1' /a 27c/
<br /> Fax - 813 - 78042021
<br /> Permit Application
<br /> Date Received '3 16 lb
<br /> Phone Contact
<br /> for Permit WERE 1 iLZ, 3 1 (�
<br /> Owner's Name I— /
<br /> /Z�4 a,.. Owner's Phone Number T
<br /> Owner's Address 5.57.5 y3 _ B t /'0 ,/ /46jc , 3.5s1/
<br /> Fee Simple Titleholder Name Titleholder Phone Number I I I I I I
<br /> Fee Simple Titleholder Address I
<br /> ,:;a , ..,. :, a T ,., ' . a'"I e '1., 0M„ , u' a «1` UMBRMS f?.' SEas ..> ea Ir �a 1 : " s ,c " >
<br /> Job Address �53� GAt� 45 LA) 2n2Jo ky 'Xk ,. *JS�� ,r ,.. m . °, .._. Lot
<br /> Sub Division Parcel #
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<br /> r w a,:1; v,.; k Ar �4144vi ..J.R§iA t 0 „ ,e.,s , nw
<br /> MI Bio-Hazard Waste Storage - ANNUAL r----1 Fumigation Tent
<br /> `gi Comm xhaust Kitchen Hood /Duct I Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> IIIIII Contro e -- I I Hood Installation
<br /> I I Emergency Generator < 30 kw I
<br /> LP /Natural Gas - Installation
<br /> I I Emergency Generator > 30 kw I I LP /Natural Gas - ANNUAL Sale
<br /> 1 Fire Protection Maintenance - ANNUAL I I Places of Assembly - ANNUAL '� '
<br /> �
<br /> I(2trlyl ISemil Other
<br /> Sprinkler 71 ❑ ❑ ❑ I Recreational Bum
<br /> e6
<br /> Fire Alarm TI ❑ ❑ ❑ I Sparklers (D, , 3a
<br /> Hood Cleaning n ❑ ❑ ❑ I I Sprinkler System Installations � l
<br /> Hood Suppression I ❑ ❑ ❑ I I Standpipes (Sprinkler Sys)
<br /> I 1 Fire Alarm Installation I Torch Roofing/Tar Kettle ( .71 il J
<br /> I Fire Pumps r 1 Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> Flammable Application- ANNUAL I I Valuation of Project
<br /> 71 Fuel Tanks
<br /> ET Other: I
<br /> ....,: .v 3a sa&ZIEt w a ..,: b " `M :� I - :;'.s« .. tg.C, .�. �_ lEkd�,ad,. tom' NWZi,r.3 .. ,.ea ... �......�.,,s.. V u
<br /> ".'..d,"rsa.0 - , ...: a<»:��.^:a:w3's t" ..'; ' . .°,., ti:; z. ;fur;:, a cw..: ,�.,_�,"'�1t:
<br /> Contractor C mpany �y+O p/ jr ���� �- I
<br /> Signature Registered Y / N Fee Current 1 Y / N
<br /> Address y'] . r d /� g.te tp 7t3 License # 033 3 85 -00 7 60
<br /> ELECTRICIAN I Company
<br /> Signature Registered Y / N j Fee Current 1 Y / N
<br /> Address I I License #
<br /> PLUMBER Company
<br /> Signature Registered Y / N Fee Current I Y / N
<br /> Address I License # I
<br /> MECHANICAL Company
<br /> Signature Registered Y / N Fee Current I Y / N
<br /> Address I License # 1
<br /> OTHER
<br /> Company
<br /> Signature Registered Y / N I Fee Current I Y / N I
<br /> Address I License #
<br /> Directions:
<br /> i� ..,Y ,w__ �. _ �. a .a, •..: �._., _�u : ,
<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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