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813 -780 -0020 City of.Zephyrhills' Fire; < < Fax -813 -780 -0021
<br /> Permit Application
<br /> Date Received ViRlff d d Phone Contact for Permit 1
<br /> Owner's Name G Iv ` 9Q Ail CO( i mam) D - Owner's Phone Number 77
<br /> Owner's Address 3 2 y q S A Aw
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address I I
<br /> .`."" ';rn :Y<,t. +a, .. ": 1 +...a- «* "'� r. m,.. .a.'. .,,. : °,.. ...,.�.::::: +.,,, -.. .... ,_ �.:.x w. «,_•,..<L .te ,::.;'; '�".,�.-` ,_,.- aeti'?. a,1?y%&,"� * t�.a; a;.'.Ys .� ,:: ;m"
<br /> Job Address Lot #
<br /> Sub Division Parcel #
<br /> '�"'".. 2r_•e•.t; s , R
<br /> ( ,„ ... • r _ .y .m;., r. .rte . . .. _ _. _ ror ,,..* ��.. •-•• ss- _-��.� s+.,..:�.a _ +s;:r - ^a,�M ;�- a : ,a s:.r „�:.r
<br /> Bio -Hazard Waste Storage - ANNUAL Fumigation Tent
<br /> Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> n Controlled Bum I Hood Installation
<br /> h Emergency Generator < 30 kw I LP /Natural Gas - Installation
<br /> I I Emergency Generator> 30 kw LP /Natural Gas - ANNUAL Sale
<br /> n Fire Protection Maintenance - ANNUAL E Places of Assembly- ANNUAL
<br /> futrly' !Semi1 raj other
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I I I Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ I I n Sprinkler System Installations
<br /> Hood Suppression ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys)
<br /> I I Fire Alarm Installation I Torch Roofing/Tar Kettle
<br /> FR Fire Pump I I Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> Flammable Application- ANNUAL I I Valuation of Project
<br /> r 1 Fuel Tanks
<br /> FT Other: I I
<br /> '` %E"xiatot$o "'K}RGi'sb -MBE :5'r"#"9u. bkx »',;ac•dt4F.>',±#.:ti :,H^„ *4, a.::,nr ., v.. 5,,. .z ✓,�+. r- ,.;-. e3.vz.;, r.. +.'a.:<Yh5 x3 .a,?`,: ,.a".,.'S-.LF; r.,i:«9kak6'N'.!"a „ Z - n-: a, T. Y'.. a1: r�' Fk4a::_ T mo4`"»`K':, 2sn4' vrr, .4si_..;�
<br /> Contractor
<br /> 7% �zC�Ya /1Z e Registered Y/ N I Fee Current I Y/ N I
<br /> Address I I License #
<br /> ELECTRICIAN Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N I
<br /> Address I I License # •
<br /> PLUMBER Company I
<br /> Signature Registered Y/ N 1 Fee Current I Y / N
<br /> Address I I License #
<br /> MECHANICAL Company I
<br /> Signature Registered Y/ N 1 Fee Current I Y / N
<br /> Address I I License #
<br /> OTHER Company I
<br /> Signature Registered Y / N ] Fee Current I Y / N 1
<br /> Address License #
<br /> Dir
<br /> Dir ecti ons: ons: � ,. ._.. M _ . s' . 5 -- _ ...,,..
<br /> ..,. ,
<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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