Laserfiche WebLink
_ -813 -780 -0020 City of.Zephyrhills Fire Fax -813 -780 -0021 <br /> -Permit Application <br /> r <br /> / Phone Contact for Permit <br /> Date Received �., � . _ _ _ . I <br /> - � tee.,., �_ 4aP.���ri_ N �.��,�, . _�::�w�� . <br /> Owner's Name 1 2 &"P // ' Y/1`12 L S 4J4-7 Owner's Phone Number I 1 <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee SimpleTitleholder Address I <br /> Job Address % 0 ,j() 91/i t% ' Lot # <br /> Sub Division Parcel # I <br /> 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 /> nl Controlled Bum n 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 /> I Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> IUtrlyl Semi) 7 Other <br /> Sprinkler ❑ ❑ n Recreational Bum G (� <br /> 7j <br /> Fire Alarm ❑ ❑ ❑ I I n Sparklers / ( <br /> Hood Cleaning n ❑ ❑ ❑ I . I n Sprinkler System Installations <br /> Hood Suppression El ❑ ❑ ❑ 1 n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> I-1 Fire Pumps n Waste Tire Storage ANNUAL <br /> 7 Fire Works <br /> 1 1 Flammable Application- ANNUAL <br /> 1 ( Valuation of Project <br /> 1 Fuel Tanks <br /> Q Other: <br /> « s <br /> u. rrirr� += ri. ii..rar�- s ,riK.rrn.ir - .r. <br /> Contractor Company ( ,)7" - F �J <br /> Signature Registered Y / N . 1 Fee Current ( Y / N <br /> Address I I License # <br /> ELECTRICIAN Company <br /> Signature <br /> I Registered Y / N I Fee Current I Y / N J <br /> Address I I License #. I I <br /> PLUMBER Company <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I I ' License # I <br /> MECHANICAL Company <br /> Signature Registered Y / N I Fee Current I Y / N J <br /> Address I I License # I <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address License # <br /> Directions: <br /> • <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) <br />