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813 -7$0 -002. City of Zephyrhills Fire ( 6 If ' Fax -813- 780 -0021
<br /> Permit Application
<br /> Date Received g_ O S /2. /0 Phone Contact for Permit I g 13 IS 1 gssy
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<br /> Owner's Name 1 L 74-S2_1_0 �.1 0
<br /> 1_0 ✓ 1 Tt1 Owner's Phone Number I a t .J I.. ! p 351
<br /> ?` Owner's Address O. $O)(9738 77-91-94 1 336 7*
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address I I
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<br /> y ( Job Address BAfl ■S it, lik711k f ,92/7 641.1_ ,LYD, Lot#
<br /> Sub Division Parcel # I
<br /> (Obi AINLU I I I Y I AX NO I I(..t)
<br /> n Bio -Hazard Waste Storage - ANNUAL Ti Fumigation Tent
<br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> n Controlled Bum 4 = Hood Installation
<br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation 3cQ C -
<br /> n Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> n Fire Protection Maintenance - ANNUAL 9- n Places of Assembly- ANNUAL
<br /> Sprinkler E n Recreational Bum
<br /> Fire Alarm ✓ n Sparklers
<br /> `•od C - -n /Suppression 0 n Sprinkler System Installations
<br /> n Fire Alarm Installation n Standpipes (Sprinkler Sys)
<br /> n Fire Pumps nI Torch Roofinc
<br /> FT Fire Works n Waste Tire Storage ANNUAL
<br /> n Flammable Application- ANNUAL
<br /> n Fuel Tanks I I Valuation of Project
<br /> n Other: 1 WOOD CL /J /A/C s 1 '1r I
<br /> Contractor Company u4 4/ J� � //� � s� �Vi(i� I
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<br /> Signature > C Registered Y / NJ Fee Current Y / N T I
<br /> Address I I License # I
<br /> ELECTRICIAN Company I
<br /> Signature Registered Y / N 1 Fee Current I Y / N J
<br /> Address I I License # I I
<br /> PLUMBER Company I
<br /> Signature Registered Y / N I Fee Current I Y / N j
<br /> Address I I License # ( I
<br /> MECHANICAL Company I
<br /> Signature Registered Y / N J Fee Current I Y / N j
<br /> Address I I License # I I
<br /> OTHER Company I
<br /> Signature Registered Y / N I Fee Current I Y / N
<br /> Address License # j I
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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.
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