Laserfiche WebLink
813-780-0020 D � City of.Zephyrhills Fire. I Q Cj f 0 <br /> / Fax - 813- 780 -0021 <br /> ply Permit Application <br /> Date Received 1 I QS % � © Phone Contact for Permit xx --c4.4.5 3s7 <br /> Owners Name LAS2L -0 '7 V / IT' Owner's Phone Number g 3 S`TS - 93. l <br /> Owner's Address ?G. BOX / 73 T , TM / FL ?3671 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I I <br /> _ ,.arum:.. ..;r.rt;, ,..,.; «,....z.a� x s. ,.•,:�v.c;..�- .,�sn;� - a—..r ,. x. "r- ,. <br /> /�( A� Q (� ]� .. , <br /> Job Address i N / 73 V �` I ' / /-C E LAO lL"" ' Lot* <br /> Sub Division <br /> Parcel <br /> I 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 I Hood Installation <br /> n Emergency Generator < 30 kw - LP /Natural Gas - Installation <br /> I Emergency Generator> 30 kw I 1 LP /Natural Gas - ANNUAL Sale <br /> I Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL <br /> )(Any Ibemil pkili 1 Other <br /> Sprinkler n ❑ ❑ ❑ I Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I Sparklers <br /> Hood Cleaning I� 12 ❑ ❑ I I I Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I 1 [1 Standpipes (Sprinkler Sys) <br /> I Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> 1 Fire Works <br /> 1 I Flammable Application- ANNUAL f • ( Valuation of Project <br /> n Fuel Tanks <br /> n Other: 1 <br /> Contractor Company Ull// V SE J 7`�V ICES 1 <br /> Signature Registered Y / N 1 Fee Current Y / N 1 <br /> Address I I . License # <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N I Fee Current I Y / N 1 <br /> Address 1 I License # I I <br /> PLUMBER Company I <br /> Signature Registered Y / N Fee Current I Y / N I <br /> Address I I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y / N 1 Fee Current I Y / N I <br /> Address I 1 License # I <br /> OTHER Company I <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address License # I <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 (httpJ /appraiser.pascogov.com) <br />