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813- 780 -0020 City of Zephyrhills Fire 4 q Z , ' Fax -813- 780 -0021
<br /> Permit Application
<br /> Date Received I /7---„e s ( Co Permit =
<br /> �� �j Phone tact or it
<br /> Owner's Name �_ H / 7, 7�V ( i /�y Owners Phone Number f
<br /> Owner's Address
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address 1
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<br /> Job Address 6 2 / / C�,L kg //) I T / /A2 Lot #
<br /> Sub Division Parcel #
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<br /> E 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 /> I I Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> n Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale
<br /> ri Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL
<br /> ItitriyI'Semi 177 tither
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I 1 n Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ I I Sprinkler System Installations
<br /> Hood Suppression n ❑ 1:1 ❑ I ( I ( Standpipes (Sprinkler Sys)
<br /> Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> Fire Pumps n Waste Tire Storage ANNUAL
<br /> n Fire Works
<br /> I Flammable Application- ANNUAL ( ( Valuation of Project
<br /> n Fuel Tanks
<br /> I I Other: I
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<br /> Contractor Company I
<br /> Signature Registered Y/ N Fee Current L Y/ N I
<br /> Address / License # I
<br /> ELECTRICIAN Company I
<br /> Signature Re gistered Y/ N I Fee Current I Y/ N j
<br /> Address I 0;--g-gd---'/Q I License # I
<br /> PLUMBER (f�' Company I
<br /> Signature '' Registered Registered Y N I F ee Current I Y/ N I
<br /> Address I L.— —'. License # I I
<br /> MECHANICAL Company I
<br /> Signature Registered Y/ N I Fee Current 1 Y / N I
<br /> Address License # I I
<br /> OTHER ( Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N I
<br /> Address 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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