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813 -780 -0020 City of.Zephyrhills Fax -813 -790 -0021
<br /> Permit Application _ _
<br /> Date Received Phone Contact for Permit
<br /> Owner's Name , p I /e 671./ (11���c a...se Owner's Phone Number Q13 :As sh /!19
<br /> ,
<br /> Owner's Address i.?y9 .�• 4' 2,504,14;/4 l
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address I
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<br /> Job Address Lot #
<br /> Sub Division Parcel #
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<br /> El Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent
<br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> I - 1 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 /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> IUtny1 ISemi1 Other
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ ( 1 n Sparklers
<br /> Hood Cleaning n 0 ❑ ❑ I I I I Sprinkler System Installations
<br /> Hood Suppression ® ❑ ❑ 1 1 n Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> Fire Pumps n Waste Tire Storage ANNUAL
<br /> n Fire Works
<br /> n Flammable Application- ANNUAL I I Valuation of Project
<br /> n Fuel Tanks
<br /> El Other: I
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<br /> Contractor Company
<br /> Signature Registered Y / N J Fee Current I Y / N j
<br /> Address I I License # I I
<br /> ELECTRICIAN Company
<br /> Signature Registered Y / N I Fee Current I Y / N j
<br /> Address 1 1 License # I
<br /> PLUMBER Company I
<br /> Signature Registered Y / N I Fee Current I Y / N I
<br /> Address I I License # I I
<br /> MECHANICAL Company
<br /> Signature Registered Y / N I Fee Current I Y / N j
<br /> Address 1 I License # I
<br /> OTHER ■ ` ' � Company p e ., _
<br /> Signature Registered ;Kam Fee Current tit=
<br /> Address -
<br /> License # ' ' rim �
<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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