|
613- 780-0020 City of.Zephyrhills Fire / 0`7 3'f Fax -813- 780 -0021
<br /> Permit Application
<br /> Date Received I 1 Phone Contact for Permit I I I
<br /> Owner's Name I —3 6R -R-I f I i t 5 ro L R., R. .I.H.L Owner's Phone Number g3 7 g1 1 19V/
<br /> Owner's Address S 70 7 f 6-A IA.. 3 /✓n. 2s 33%-y Z
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address I
<br /> Job Address Lot #
<br /> Sub Division Parcel #
<br /> mionrte unam , '. 5 _. �;�.er o,n. ::.i, - ..m 3: �x ,, ug
<br /> ..�..._:.x�.,... ,ems . a�,.��. a ;.�.s:��. �"�.��k�.. -..;fir. - , +�: �. ,r�c. ....n.a -. ... � .���.��._ .,.���.,a�'..;:F:
<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 /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> El Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> n Fire Protection Maintenance - ANNUAL ® Places of Assembly- ANNUAL
<br /> � JQtrlyl ISemil Other
<br /> Sprinkler ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I I Sparklers
<br /> Hood Cleaning IT ❑ ❑ ❑ I n Sprinkler System Installations
<br /> Hood Suppression El ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> El Fire Pumps n Waste Tire Storage ANNUAL
<br /> El Fire Works
<br /> n Flammable Application- ANNUAL I 1 Valuation of Project
<br /> �� Fuel Tanks
<br /> n Other: I
<br /> Contractor Company
<br /> Signature Registered Y / N J Fee Current I Y / N I
<br /> Address I
<br /> ( License # I I
<br /> ELECTRICIAN Company
<br /> Signature I Registered Y / N I Fee Current I Y / N I
<br /> Address I I License #
<br /> PLUMBER Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N I
<br /> Address I I License # I
<br /> MECHANICAL Company _ 1
<br /> Signature Registered Y/ N I Fee Current I Y/ N I Y
<br /> Address I I License # I
<br /> OTHER Company
<br /> Signature Registered Y/ N I Fee Current Y/ N I
<br /> Address IJ ( License # J I
<br /> `3 n $ `&'i aaees a. a,4., s... u. &:aaa tzaa:�' smma ».:.,,,,, , a.,,,..,, b., ,,,, ,,i,, <,,„, . ,..r.,_ x..&o,�m .,, ,,,�:;aa
<br /> Directions: ..e�� u �.T,� ,..� �m� ,.
<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 />
|