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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 ( J
<br /> - - ,. ". I ., / x,
<br /> Owner's Name f A) e---C E A. Owner's Phone Number 7! 3 1 - MN
<br /> Owner's Address �I 7- / f .r ��, ��,,r 47-,,, ,1
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address I
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<br /> Job Address Lot #
<br /> Sub Division Parcel #
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<br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent
<br /> Comm Exhaust Kitchen Hood /Duct I I 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 /> I - 1 Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> IQtriy) ISemiI I Other iU 11
<br /> Sprinkler E ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑.. ❑ ❑ I 1 I 1 Sparklers .
<br /> Hood Cleaning V ❑ ❑ 1 1 n Sprinkler System Installations
<br /> Hood Suppression 0 ❑ ❑ ❑ ( 1 n Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> n Fire Pumps n Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> 7 Flammable Application- ANNUAL 1 I Valuation of Project
<br /> n Fuel Tanks
<br /> fl Other: 1 - 1 kr (4- 119 gv? 7 I
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<br /> Contractor Company � _ �G''► /`-/, , y ✓eSf..,�.,e I
<br /> Signature ) ie — 7= Registered Y / N I� Fee Current 1 Y / N ] 4../•5L
<br /> Address I License # I I
<br /> ELECTRICIAN Company I
<br /> Signature I Registered Y/ N ] Fee Current I Y / N I
<br /> Address 1 I License # I
<br /> PLUMBER Company I
<br /> Signature Registered Y / N ] Fee Current I Y / N I
<br /> Address I I License # I
<br /> MECHANICAL Company I
<br /> Signature Registered Y/ N I Fee Current 1 Y / N I
<br /> Address I I License # I
<br /> OTHER Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N
<br /> Address I 1 License # I
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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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