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813-780 -0020 City of Zephyrhills Fire i / 1 -r
<br /> Fax - 813- 780 -0021
<br /> Permit Application
<br /> Date Received 1 ''%'1 Zc ( ( Phone Contact for Permit I tl 3 II I (o I b w b9 1
<br /> Owners Name QeeC t y' `t#1�j , '7 SO 7 ?l
<br /> Ca a S Owners Phone Number
<br /> Owner's Address -7 t33 ( S'\ Jc, ZP pL.7rL . ,Us 3 3 S�-t
<br /> Fee Simple Titleholder Name C Titleholder Phone Number
<br /> Fee Simple Titleholder Address I
<br /> wila.,, a.rvF,.. u`B:aa,tili,a? .z t,:ag ... ... .:„ ir<tt"
<br /> Job Address Prw/ E Lot #
<br /> Sub Division Parcel #
<br /> '�. a'^ asaiaa4`;ck.?^,��';. rx c$AnZS�Sm.4,.,Maaa..s. ams.�.a... Q -s;.i,a . ,,.t. .. .H;: *„ ,.4sa. „z.. 4. _:
<br /> FT Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent
<br /> n Comm Exhaust Kitchen Hood /Duct I I Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> n Controlled Bum n Hood Installation
<br /> I I Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> [ Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL
<br /> lUtrlyI (Semi) Utner
<br /> Sprinkler ❑ ❑ ❑ I Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ 1 1 n Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ 1 n Sprinkler System Installations
<br /> Hood Suppression FT1 ❑ ❑ eif I 1 I 1 Standpipes (Sprinkler Sys)
<br /> T7 Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> FT Fire Pumps n Waste Tire Storage ANNUAL
<br /> H Fire Works
<br /> Flammable Application- ANNUAL 1 Z 2– - 4 =-5" I Valuation of Project
<br /> n Fuel Tanks
<br /> n Other: I
<br /> a. :.,,,I . vake, ""Hai zs; a .F. , . _ ,,z„ ,. M,;.,,f , . .,.. , ,y >:: ,' i- . :. ., � a r, , ,,.;IX _''"° .r. jai: s i ltai &Z : u.!arg ,.a . V:v. .a " giik a ;, . u.. .... . a: ,,,,
<br /> Contractor — :— _ Company F/' F'
<br /> , , Al /- 0' , /,,t 4-
<br /> Signature - Registered W N I Fee Current 1 Y / N
<br /> Address I AO. 730/( 06g 1-4 O' Let. k s 3L{ (o3'7 I License# I
<br /> ELECTRICIAN Company
<br /> Signature Registered Y / N , Fee Current I Y / N
<br /> Address
<br /> I License # I I
<br /> PLUMBER Company
<br /> Signature Registered Y / N ] Fee Current I Y / N
<br /> Address I License #
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N ] Fee Current 1 Y / N 1
<br /> Address I
<br /> I License # I
<br /> OTHER Company
<br /> Signature Registered Y / N ' Fee Current 1 Y / N
<br /> Address 1 License #
<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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