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813 -780 -0020 City of Zephyrhills Fire tr f V I 71 _ F. 1 , 780 -0021
<br /> Permit Application CCCIC '
<br /> Date Received * /, ®,Q Phone Contact e 33
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<br /> — Owner's Name l_1 ``. 1 '0zf _ S 0Q, 1Q .\—c Owner's Phone Number —
<br /> — Owner's Address kali, 6Z L.Ak X1'1 Q p ) / ik V�A R� / f ')`.. S(4 g Q
<br /> Fee Simple Titleholder Name , ` Titleholder Phone Number Ct .. 1 (0•14 1 (P
<br /> Fee Simple Titleholder Address I
<br /> y Job Address 3 R5 , S OZ_ � � _ H '(, -) Lot #
<br /> Sub Division Parcel #
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<br /> 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 I I 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 /> IQtriyi ISemil I LJ Other d ,47,x____
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum e
<br /> Fire Alarm n ❑ ❑ 0 I I n Sparklers `10.
<br /> Hood Cleaning n ❑ ❑ ❑ I n Sprinkler System Installations
<br /> Hood Suppression 1 ❑ ❑ I I n Standpipes (Sprinkler Sys)
<br /> El 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 I Valuation of Project
<br /> n Fuel Tanks
<br /> s l Other: I CQo.) % 1 F o ice 1
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<br /> Contractor J Company
<br /> Signature �'c�` Registered Y / N I Fee Current I Y / N
<br /> Address I License # I J
<br /> ELECTRICIAN - Company I
<br /> Signature I Registered Y / N I Fee Current I Y / N I
<br /> Address I I License #
<br /> PLUMBER Company
<br /> Signature Registered Y / N I 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 #
<br /> OTHER Company
<br /> Signature Registered Y/ N j Fee Current I Y/ N
<br /> Address,' License# 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. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com)
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