|
813- 780 -0020 City of Zephyrhills Fire Fax-813-780-0021
<br /> Permit Application
<br /> Date Received Phone Contact for Permit , I J I
<br /> I
<br /> Owner's Name ,- '7,45/k b/4 (/ /9 / c,, h 8 Q / , 7,6.1 Owner's Phone Number
<br /> Owner's Address s"
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Ad
<br /> Job Address !mob 4 ' FO / „Z _.,�LGZ - ___C'`''7;■2/c — Lot #
<br /> Sub Division Parcel #
<br /> ,•...
<br /> :._...: a. �. R`. 5' ��: a:: h:. �C� .,m.�,..,���«w�.�::;�.,�.<�:�' '��'� €�s" ;.:� ;�;.;�, °,* r� , - , ° `�.'.'raMMEgainni'.w;' M:a - °' ,E . :. n:a r. � . ra'mZEWZA: , r .,a "_.da5..5=...
<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 /> In Emergency Generator < 30 kw I I LP /Natural Gas - Installation
<br /> El Emergency Generator > 30 kw LP /Natural Gas - ANNUAL Sale
<br /> n Fire Protection Maintenance - ANNUAL Places of Assembly -ANNUA m i J y \
<br /> �Qtrlyl e Other f (
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum // �---
<br /> Fire Alarm 0 ❑ ❑ ❑ I 1 I 1 Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ I n Sprinkler Systen`i Install- •
<br /> Hood Suppression 0 ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> n Fire Pumps Ti Waste Tire Storage ANNUAL
<br /> n Fire Works
<br /> Flammable Application- ANNUAL I ( Valuation of Project
<br /> r --- 1 Fuel Tanks
<br /> FT Other: I
<br /> .......;.a 2 :m ".a .<, r-a Iatn,! .; ' d" ....,,,,,, ,.: — ;, .,,.rya ,: s.,,,AMIz" °814 ;'"c.4 ,; ^, ..#•;. n :. _ ca a vim . .., .0 MBKii i ZI UMMErk l ,
<br /> Contractor / Company ,d� rte; G 04. ,, 1
<br /> 1 '`i G'
<br /> Signature ���` /�r ii2 Registered Y / N I I Fee Current 1 Y / N . I
<br /> Address , • �i/rw License #
<br /> ELECTRICIAN Company
<br /> Signature I Registered Y / N I Fee Current I Y / N
<br /> Address I I License # I
<br /> PLUMBER Company
<br /> Signature Registered Y/ N I Fee Current I Y/ N I
<br /> Address 1 1 License #
<br /> MECHANICAL Company
<br /> Signature Registered Y / N j Fee Current 1 Y / N I
<br /> Address I I License # I
<br /> OTHER Company
<br /> Signature Registered Y / N _I Fee Current I Y/ N I
<br /> Addr License #
<br /> 3:Z T n.. ", „ ,,,k_Mw.,aa, sax.�.cu. w.8,, ..1, ar,.... 1:?.s.A4,4 oie t,z;, d.6sa. ..,-., .:.:a ”" 4 ;.raa a: ..* i ,,_ 3.�risae..a7.,�ea '�
<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)
<br />
|