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813 - 780 -0020 City of.Zephyrhills Fire ` 100 Fax - 813- 780 -0021
<br /> Permit Application
<br /> Date Received I Phone Contact for Permit
<br /> °.� . • '°' , I I l
<br /> Fran r ©
<br /> Owner's Name (4 1 �� �j 04 at I _ -1 __ R 1i ' hone Number O Ca
<br /> Owner's Address
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee SimpleTitleholder Address I
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<br /> Job Address Lot #
<br /> Sub Division Parcel #
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<br /> FT 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 /> Controlled Bum I I Hood Installation
<br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> n Emergency Generator > 30 kw ^ _LP1Natural- Gas-ANNUAL. Sale
<br /> n Fire Protection Maintenance - ANNUAL Places of Assembly - ANNUAL
<br /> IQtrlyl ISemiI FT 1 L EM _
<br /> Sprinkler ❑ ❑ ❑ Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I ( I Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ I I I Sprinkler System Installations
<br /> Hood Suppression 0 ❑ ❑ ❑ 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 /> n Fire Works
<br /> �
<br /> (� Flammable Application- ANNUAL
<br /> 1 1 Valuation of Project
<br /> I� Fuel Tanks
<br /> 0 Other: I
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<br /> Contractor Company
<br /> Signature a,.-41,4__, J �_� Registered Y / N Fee Current I Y / N Address I ( License # I I
<br /> ELECTRICIAN Company
<br /> Signature I Registered Y/ N 1 Fee Current I Y/ N I
<br /> Address I I License # I
<br /> PLUMBER Company
<br /> Signature Registered Y/ N . 1 Fee Current I Y / N I
<br /> Address I I License #
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N 1 Fee Current 1 Y / N I
<br /> Address I I License # 1
<br /> OTHER Company
<br /> Signature Registered Y / N J Fee Current I Y/ N
<br /> Address) 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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