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813-780-0020 City ofZephyrhills Fire. Itio(9?-7
<br /> Fax- 813 -780 -0021
<br /> Permit Application
<br /> Date Received - Phone C for Permit
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<br /> Owner's Name STMPT,FXGRINNF,LL /, erily( V'Oh 1 Se Owner's Phone Number 1 813 626 5482
<br /> Owner's Address 4701. Oak Fair Blvd TAMPA FL 33610
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<br /> Fee Simple Titleholder Name - 1 Titleholder Phone Number
<br /> Fee SimpleTitfeholderAddress I .
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<br /> Job Address J`625() -t . Z e,Pi i r h As L- A3`5 L42. Lot #
<br /> Sub Division Parcel #
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<br /> I. I Bio- Hazard Waste Storage - ANNUAL I I Fumigation Tent
<br /> I Comm Exhaust Kitchen Hood /Duct r 1 Hazardous Material (Tier If or RQ Facility) ANNUAL
<br /> I I Controlled Bum I I Hood installation
<br /> Emergency Generator < 30 kw I I LP /Natural Gas - Installation
<br /> I I •Emergency Generator > 30 kw ' I 1 LP /Natural Gas - ANNUAL Safe
<br /> 1 I • Fire Protection Maintenance - ANNUAL • I I Places of Assembly-ANNUAL
<br /> _ 'Lady! JSemiI lAnl j Other -
<br /> Sprinkler, I I ❑ - ❑ ❑, ! � Recreational Burn
<br /> . Fire Alamo 11r ❑ ❑ I - , I : I I Sparklers
<br /> . • Hood Cleaning I I D ' ❑ ❑ I 1 I .. I Sprinkler System Installation
<br /> Hood Suppression I 1 ❑ O ❑ ) f I I Standpipes (Sprinkler Sys);.
<br /> 1 .-z I Fire Alarm Installation 1 Torch Rooftng/ Tar Kettle
<br /> I, 1 Fire Pumps I Waste Tire Storage ANNUAL
<br /> I : I . Fire Works •
<br /> I I. Flammable Application- ANNUAL , O PrOJect
<br /> V aluati f
<br /> I I Other: I
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<br /> Contractor Company 3 ( j r f •Sn -l!. C{
<br /> Signature Registered Y / NI Fee Current I. Y / N I
<br /> a Addr 3 I . . ::.•, . -
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<br /> I. ' License # ..I
<br /> ELECTRICIAN -'
<br /> Company . = ,- :
<br /> Signature - ''' = , , .
<br /> • . , Registered Y / N I Fea Current I - ; / N: �.Y
<br /> Address I I License # I
<br /> PLUMBER t
<br /> • _ _ Company
<br /> Signature ' ' Registered Y / N A Fee Current' I Y / N• t: •
<br /> . Address I , . ` 1
<br /> I License # . . I
<br /> MECHANICAL Company
<br /> Signature . Registered Y / N _I Fee Current 1 Y / N I
<br /> Address I, :.: - , 1 License #
<br /> OTHER - Company . .
<br /> Signature Registered Y / N I Fee Current 1 Y / N ,
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<br /> Address 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 inquired _(Mechanical work over $5000) .
<br /> - Supply two (2) sets of drawings with applicable documentation
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<br /> Allow 10 -14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http lfappraiser.pascogov.com)
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