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813 -780 -0020 City of Zephyrhills Fire Fax -813 -780 -0021 .
<br /> Permit Application - -
<br /> Date Received on a Contact for Permit
<br /> Phone
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<br /> Owner's Name 1 J? J &o "ie effilAS7 dh4CcJ Owner's Phone Number I ie/.3 17P.2- 1 133 /1
<br /> Owner's Address A 6 w-C, BL/Jb ,Zs1�/�ti //f P
<br /> Fee Simple Titleholder Name / Titleholder Phone Number I I I
<br /> Fee Simple Titleholder Address I I
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<br /> Job Address Lot #
<br /> Sub Division 1 Parcel # I I
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<br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent
<br /> I Comm Exhaust Kitchen Hood /Duct n 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 /> n Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> I Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> lutriyl lSemi Other
<br /> Sprinkler D ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ 1 1 n Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ 1 1 n Sprinkler System Installations
<br /> Hood Suppression I2 ❑ X ❑ I 1 n Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> n Fire Pumps n Waste Tire Storage ANNUAL
<br /> H Fire Works
<br /> Flammable Application- ANNUAL I I Valuation of Project
<br /> El Fuel Tanks
<br /> 0 Other: I I
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<br /> Contractor Company
<br /> Signature Registered Y/ N 1 Fee Current I Y/ N I
<br /> Address I I License # I
<br /> ELECTRICIAN Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N
<br /> Address I I License # I I
<br /> PLUMBER Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N I
<br /> Address I I License # I
<br /> MECHANICAL Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N I
<br /> Address ( I License # I I
<br /> OTHER r Company r, 7 _ ., �..
<br /> Signature / � 1 Registered t4�� Fee Current FAVIII
<br /> Address / License # I c a "aooO /.2ao G
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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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