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813-780 -0020 City of.Zephyrhills Fire Fax- 813 - 780 -0021
<br /> Permit Application
<br /> ate Received I Phone Contact t for
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<br /> Owner's Name RT o Conn- -r v c. m\ =vvc Owners Phone Number 1 5613 1 1V ia I `'
<br /> Owner's Address V 5344 i ii4 slye l Z _ 1 11 o tt \c , f L 13542,
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee SimpleTitleholder Address
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<br /> Job Address ✓ 5344 S�1 , hhl rh; ll s ` E -33942_ Lot #
<br /> Sub Division Parcel #
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<br /> wu El 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 /> El Emergency Generator > 30 kw n LP /Natural Gas - ANNUALS �/
<br /> Fire Protection Maintenance - ANNUAL n Places of Assembly -A UAL j( 0 / /
<br /> lorly !Semi' (;y11 Lal. I
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm 17 ❑ ❑ :. n Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ I I I Sprinkler System Installations
<br /> Hood Suppression n ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> nl Fire Pumps n Waste Tire Storage ANNUAL
<br /> n Fire Works
<br /> Flammable Application- ANNUAL ` ( Valuation of Project
<br /> 17 Fuel Tanks
<br /> El Other: I
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<br /> Contractor Company BraaaV elo . ] Ci u y \444 1
<br /> Signature j/ k,A,}(� Registered Y / N Fee Current I Y / N J `
<br /> Address I License # I J
<br /> ELECTRICIAN Company
<br /> Signature I Registered Y/ N Fee Current I Y / N I
<br /> Address I I License #
<br /> I
<br /> PLUMBER Company
<br /> Signature Registered Y/ N j Fee Current I Y / N
<br /> Address I I License #
<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 ] Fee Current I Y/ N I
<br /> Address
<br /> 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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