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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021
<br /> Permit Application
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<br /> Date Received L Phone Contact for Permit
<br /> Owner's Name LUs G,(i CVs Owner's Phone Number cY/S I 78"..2 I ones
<br /> Owner's Address SP 3OL2 /1 - 4vE Ze;o/�1, -1,A k
<br /> Fee Simple Titleholder Name / Titleholder Phone Number
<br /> Fee Simple Titleholder Address I I
<br /> .i 0, ,,,,,„.0, ° i , , ,, , ;.' I? .. �v:a '""1 .; S.: ,; a k 1 ∎- per.:, ° 4 :"' m oo t'.
<br /> Job Address Lot #
<br /> Sub Division I Parcel #
<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 /> El Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> El Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> n Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL
<br /> (Qtrlyl !Semi/ Eal Other
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ 1 1 n Sparklers
<br /> Hood Cleaning V. ❑ ❑ 1 1 1 1 Sprinkler System Installations
<br /> Hood Suppression ❑ , ❑ I I n Standpipes (Sprinkler Sys)
<br /> El Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> El Fire Pumps I I Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> n Flammable Application- ANNUAL ( ' Valuation of Project
<br /> n Fuel Tanks
<br /> n Other: 1 I
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<br /> Contractor Company I
<br /> Signature Registered Y/ N I Fee Current I Y / N I
<br /> Address I 1 License #
<br /> ELECTRICIAN Company I
<br /> Signature I Registered Y/ N I Fee Current I Y / N I
<br /> Address I I License # I
<br /> PLUMBER Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N
<br /> Address 1 I License #
<br /> MECHANICAL Company I
<br /> Signature Registered Y/ N ] Fee Current I Y/ N j
<br /> Address I I License #
<br /> OTHER Company D.rr / 7 ,,et <`tYi.',? P..47 4 L
<br /> Signature cwt Registered IMRE Fee Current P�
<br /> Address Arra3c, -40m/re/kit e . . . . r C 7 - ?3S 2d License # • co.S�OO /Y9L
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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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