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813 -780 -0020 City of.Zephyrhills Fire Fax- 813 - 780 -0021
<br /> Permit Application
<br /> Date Received Phone Contact for Permit I ri,I I il
<br /> IN 1
<br /> Owner's Name fiO A , ' . -4a, �U bu? Owner's Phone Number I g t, 11 78.:211 1381
<br /> V Owner's Address
<br /> Fee Simple Titleholder Name Titleholder Phone Number I I
<br /> Fee Simple Titleholder Address
<br /> -, aa. `iz r' ' ". ass •i ", ammi '; .. mst - `e9„ ant wm a sT ... m rm.k m '.: ,.'' ' ,..f.4,a ' ,aa ,xia. _.s.
<br /> Job Address
<br /> Lot #
<br /> Sub Division #
<br /> :, .' ., ,, valet , r ctaz: ' ? s .. , ^'. e ,eta , air's, i ..: TE MEN I;e 4
<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 /> n Emergency Generator> 30 kw ____.1---- t--tpri Gas-AN L S t
<br /> I Fire Protection Maintenance - ANNUAL 1 >d Places of Assembly - ANNUAL )
<br /> n 1Qtriy1 lSemi� Uther 1_
<br /> Sprinkler ❑ ❑ ❑
<br /> Recreatiollat
<br /> Fire Alarm ❑ ❑ ❑ I I I Sparklers
<br /> I I
<br /> Hood Cleaning ❑ ❑ ❑ I I I Sprinkler System Installations
<br /> (
<br /> Hood Suppression El ❑ ❑ ❑ I I I I Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> n Fire Pumps n Waste Tire Storage ANNUAL
<br /> FT Fire Works
<br /> n Flammable Application- ANNUAL I I Valuation of Project
<br /> n Fuel Tanks
<br /> n Other: I
<br /> Contractor Company
<br /> Signature Registered Y/ N j Fee Current I Y/ N
<br /> Address 1 License # I I
<br /> ELECTRICIAN Company
<br /> Signature I Registered Y/ N J Fee Current I Y / N I
<br /> Address 1 I License #
<br /> PLUMBER Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N I
<br /> Address I License #
<br /> MECHANICAL Company
<br /> Signature Registered Y / N ,I Fee Current I Y / N
<br /> Address I I License #
<br /> OTHER ///�, Company
<br /> Signature Aj i€1(.( (,y,� � Registered Y / N ,I Fee Current I Y / N I
<br /> Address G-d / /ei/✓e( .7 ,
<br /> SW, �a�, � , .� ,.. s „ ” .. License # 1
<br /> s� ;, mnaasa ,..... , z.cs:,s. ,'",€ s�°, ,0 .' • ivr..3A.A+.4 :,,,,,,,, a n a. aa a._ u..,,,..; sam .w.,,h.,s, ,e`'a n
<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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