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P13- 780 -0020 City of.Zephyrhills Fire Fax - 813780 -0021
<br /> Permit Application
<br /> Date Received 11111WARMII Phone Contact for Permit J
<br /> Owner's Name 1 /is- 1.o,-3-'-e___ Owner's Phone Number
<br /> Owner's Address 4 es( 1 „....i, j,
<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 /> n 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 /> 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 /> IQtrlyI 'Semi (A Other
<br /> ❑ Sprinkler ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm 17 I ❑ ❑ 01 I n Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ I I I I Sprinkler System Installations
<br /> Hood Suppression El ❑ ❑ ❑ ( 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 /> n Fire Works
<br /> n Flammable Application- ANNUAL I ( Valuation of Project
<br /> r --- 1 Fuel Tanks
<br /> Q Other: I
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<br /> Contractor
<br /> Signature 2-1_ A'' Company
<br /> I
<br /> Registered Y / N I Fee Current I Y / N
<br /> Address I AP, )1,-4/ 9'z S5 L 46tl I License # I
<br /> ELECTRICIAN Company
<br /> Signature I Registered Y/ N I Fee Current I Y/ N f
<br /> Address I I License #
<br /> PLUMBER Company
<br /> Signature Registered Y/ N J Fee Current I Y/ N I
<br /> Address I I License # I
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N I Fee Current I Y / N I
<br /> Address I I License # I
<br /> OTHER Company
<br /> Signature Registered Y/ N I Fee Current Y/ N I
<br /> Address I License #
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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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