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813-7 City of.Zephyrhills Fire Fax- 813- 780 -0021
<br /> 'Permit Application
<br /> Date Received ,L 7 Z6 lQ I Phone Contact for Permit J 9/ 1 �T I a ?6 9 I
<br /> Owner's Name . ''t \ 1 I Owners Phone Number 1 ti 3 17! 7 579/
<br /> Owner's Address XsS 6Cii /3/06) 2 `-[/ ' l US 3-
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Address I I
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<br /> Job Address �&-S ( // h air /S 735-3,-
<br /> 7 / Lot #
<br /> Sub Division Parcel #
<br /> .M ,.9" .DERNAW:MTME + 'S.3✓rt us.• :,, L.' :. , - - d , S N ..x.E I.. €<SPIZ.O.,.,. way ERMENVISMIONA..m,. "*aw14. `x+.M,eH.IUNS:AWIMt,. • ,..1.r..,m.,...ginik ' E Maa g:
<br /> n Bio- Hazard Waste Storage - ANNUAL I I Fumigation Tent
<br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> I - 1 Controlled Bum In Hood Installation
<br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> n Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> a Fire Protection Maintenance - ANNUAL I Places of Assembly- ANNUAL
<br /> IQtrly) Semil Other
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I I I I Sparklers
<br /> Hood Cleaning E ❑ ❑ ❑ I I I I Sprinkler System Installations
<br /> Hood Suppression E] ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys)
<br /> Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> n Fire Pumps n Waste Tire Storage ANNUAL
<br /> I I Fire Works
<br /> n Flammable Application- ANNUAL I I Valuation of Project
<br /> n Fuel Tanks
<br /> 1
<br /> n Other: -AIP/ _I
<br /> ...:.; «:... teeMeffette S ,t i Rau. t -. eere : ;'. e AA Ate :mss ' i a tette:st y teett ;:, `s<'» egte::e' "' , `°?.:e ... eeeteM heel ffle S a•; tattl. steM
<br /> Contractor - / Company I
<br /> Signature _ Registered Y / N . I Fee Current 1 Y / N I
<br /> Address License # I I
<br /> ELECTRICIAN Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N I
<br /> Address License # I I
<br /> PLUMBER Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N J
<br /> Address I 1 License # ( I
<br /> MECHANICAL Company I
<br /> Signature Registered Y / N I Fee Current I Y/ N I
<br /> Address I I License # I
<br /> OTHER Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N I
<br /> Address 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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