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813 - 780 -0020 City of Zephyrhills Fire Fax - 813780 -0021
<br /> Permit Application
<br /> Date Received -- for Permit
<br /> Phone Con r rmit
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<br /> Owner's Name / 7 / '/,9A(( r/r/' h Owner's Phone Number j 7k ' d 17?' /.L
<br /> Owner's Address J -S,'� 2 Sj'- e7 24;a0-1,,,f
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee SimpleTitleholder Address I I
<br /> Job Address Lot #
<br /> Sub Division I Parcel #
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<br /> I—I Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent
<br /> rI Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> n Controlled Bum n Hood Installation
<br /> Fl 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 /> IQtrlyI !SemiI LW Other
<br /> Sprinkler El ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ ( I n Sparklers
<br /> Hood Cleaning 0 ❑ ❑ ❑ [ n Sprinkler System Installations
<br /> Hood Suppression Z_ ❑ ,Ti< ❑ ( 1 n Standpipes (Sprinkler Sys)
<br /> rI Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> I Fire Pumps n Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> Flammable Application - ANNUAL
<br /> 1 I Valuation of Project
<br /> I I Fuel Tanks
<br /> r Other: I I
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<br /> Contractor Company I
<br /> Signature Registered Y / N J Fee Current I Y / N I
<br /> Address I I License # I I
<br /> ELECTRICIAN Company I
<br /> Signature I Registered Y/ N I Fee Current 1 Y/ N
<br /> Address I I License # I I
<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 I
<br /> Signature Registered Y/ N 1 Fee Current I Y/ N I
<br /> Address I 1 License # I I
<br /> OTHER r Company ' (/r! .►E w 'aia -n.7 _ G.c!
<br /> Signature < Registered wan" Fee Current rdllrlan
<br /> Address License # ' Y" s 0 /996
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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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