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<br /> 813-780 -0020 City of Zephyrhills Fire
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<br /> — ( i (-1_5 Fax- 813- 780 -0021 .
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<br /> Permit Application
<br /> Date Received Phone Contact for Permit I I
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<br /> Owner's Name I Q 1 '-
<br /> le 6 Fa m.*; l y Co r- p Owner's Phone Number
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<br /> Owner's Address PD . 1 1 6 5$ -a kyrk 1(5) Ft, 3 35ga- 4(4/9-8 Fee Simple Titleholder Name I Titleholder Phone Number
<br /> Fee Simple - Titleholder Address
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<br /> Job Address � I 6 ''j Q+ . l i k e k t f 5 3 5 cf�- Lot #
<br /> Sub Division Parcel #
<br /> ,. - ^S�F' 4da " s4'::. 4r ?$'zip. "" :b .�'r F m .:' n SY a,`A9, . 6•?wFN.a ". "�X`^ i
<br /> n Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent
<br /> 1 1 Comm Exhaust Kitchen Hood /Duct I 1 Hazardous Material (Tier II or RQ Facility) ANNUAL
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<br /> Controlled Bum I Hood Installation
<br /> Emergency Generator < 30 kw ( I LP /Natural Gas - Installation
<br /> I I Emergency Generator > 30 kw I I LP /Natural Gas - ANNUAL Sale
<br /> [ - re Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL
<br /> ILitrly) I maim
<br /> Sprinkler n ❑ ❑ i7. 1 1 Recreational Burn
<br /> Fire Alarm I ❑ ❑ I 1 1 1 Sparklers
<br /> Hood Cleaning I ❑ ❑ ❑ I Sprinkler System Installations
<br /> Hood Suppression 1 ❑ ❑ ❑ I I I Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation I I Torch Roofing/Tar Kettle
<br /> n Fire Pumps n Waste Tire Storage ANNUAL
<br /> 7 Fire Works
<br /> Flammable Application - ANNUAL
<br /> 1 ( Valuation of Project
<br /> I Fuel Tanks
<br /> I Other:
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<br /> Contractor „/ / 1 . Company & ■ ∎ re • - lib S � 1
<br /> Signature t (/V Registered Y / N Fee Current Y / N
<br /> Add - i 50 eZ 5 Gt0n`fQ ,4e (54 . 'Tp4 7(_ License# 1 14 4 6 a.7 Z,(soot oo71
<br /> ELECTRIC • N Company
<br /> Signature Registered Y/ N I Fee Current 1 Y/ N
<br /> Address I License #
<br /> PLUMBER Company
<br /> Si Registered Y/ N . 1 Fee Current I Y/ N I
<br /> Address
<br /> License #
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N I Fee Current I Y/ N j
<br /> Address I .) I License # w�
<br /> OTHER / n A /� . .. Company �� a�i� !� =157
<br /> Signatur. 1 W" Registered Y / N Fee Current Y / N
<br /> Ad. ress ', 0 a A 5 112. &. (y^ r License # ; $r ; a. iII OO
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<br /> Direction •
<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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