|
P,13780 -0020 City of Zephyrhills Fire Fax-813-780-0021
<br /> Permit Application
<br /> Date Received j Phone Contact for Perm
<br /> Owner's Name ID,i ey G Owner's Phone Number 8 7P-G 1 1-3 g.24
<br /> Owner's Address 3 72,,0 /f-' ic¢-C- ,5f— C7'-7 404,-1,,t4 /
<br /> Fee Simple Titleholder Name I Titleholder Phone Number
<br /> Fee Simple Titleholder Address I
<br /> ,,•. - .S"."� - '^ aa - ^: a , [?'s'a..'''s'a+:;a,.aa:',', .._.'- :s":.,n.t•a;.` - ,�'•a • °�%t,. .. .., .s:,:•
<br /> Job Address Lot*
<br /> Sub Division Parcel #
<br /> n Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent
<br /> JJ 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 /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> IQtrly1 SemiI Other
<br /> Sprinkler n ❑ J ❑ n Recreational Bum
<br /> Fire Alarm ❑ ❑ ❑ - ❑ I ( I I Sparklers
<br /> Hood Cleaning S , ❑ ❑ I n Sprinkler System Installations
<br /> Hood Suppression n , ❑ ❑ 0 I 1 n Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> El Fire Pumps , , n Waste Tire Storage ANNUAL
<br /> I I Fire Works
<br /> n Flammable Application- ANNUAL I I Valuation of Project
<br /> El Fuel Tanks
<br /> ni Other: 1
<br /> I
<br /> Contractor Company I
<br /> Signature Registered Y / N I Fee Current I Y/ N J
<br /> Address I I License # I
<br /> ELECTRICIAN Company
<br /> Signature I Registered Y / N I Fee Current I Y / N 1
<br /> Address I I License # I
<br /> PLUMBER Company
<br /> Signature Registered Y/ N I Fee Current I Y / N I
<br /> Address I I License*
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N 1 Fee Current I Y / N I
<br /> Address I
<br /> I License It
<br /> OTHER - ' - ri1 ,—
<br /> Signature Registered Cam Fee Current e N
<br /> Address License # ' . (� r,,. .
<br /> Dir+ections.,bons .c:.xn ..., . i:A ...,, , ,ads, - �:w�t�k :, , :a' a_ ;�z: ., ..c.. b • a .. , a�wa:�sues „ay. .� ui *, • zeta�sse.A < ., ...... ,.�,..:rs _ .,. ..,.� rs`rt `
<br /> . > ,
<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)
<br />
|