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813-780-0020 City of.Zephyrhills Fire. Fax -813 -780 -0021
<br /> � Permit Application
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<br /> AV'
<br /> Owner's Name ( X� k - Owner's Phone Number v 7'0 1, ✓
<br /> Owner's Address
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address
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<br /> Job Address • 7, 5.4/ i 4 'f Lot
<br /> Sub Division Parcel #
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<br /> I I Bio-Hazard Waste Storage - ANNUAL n Fumigation Tent
<br /> El Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> TT Controlled Bum n Hood Installation
<br /> n Emergency Generator < 30 kw 1 ( LP /Natural Gas - Installation
<br /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> Fire Protection Maintenance - ANNUAL n Places of Assembly - ANNUAL
<br /> lUtriy1 !Semi' Lj Other
<br /> Sprinkler ❑ ❑ ❑ n Recreational Burn �j
<br /> Fire Alarm ❑ ❑ ❑ 1 1 1 Sparklers ✓
<br /> Hood Cleaning El ❑ ❑ ❑ I Sprinkler System Installatio s
<br /> Hood Suppression z " 1 ❑ ❑ 1i Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation "�+----FFFF n Torch Roofing/Tar Kettle
<br /> n Fire Pumps n Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> Flammable Application- ANNUAL I ASQ, Da I Valuation of Project
<br /> Fuel Tanks
<br /> Other:
<br /> Contractor Company
<br /> Signature Registered Y / N 1 Fee Current I Y / N
<br /> Address 1 I License # )
<br /> ELECTRICIAN Company
<br /> Signature Registered Y / N Fee Current Y / N
<br /> Address l ( License #
<br /> PLUMBER Company
<br /> Signature Registered Y /' N j Fee Current I Y / N
<br /> Address l 1 License #
<br /> MECHANICAL Company
<br /> Signature Registered Y / N 1 Fee Current 1 Y/ N
<br /> Address I License #
<br /> OTHER .
<br /> pm,- v / f i#t e eD, Company
<br /> Signature ► Registered Q N I Fee Current 1 Y / N
<br /> Address es ,412r4M M;iil* License
<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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