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813-780-0020 City of Zephyrhills Fire. Fax - 813 - 780 -0021
<br /> Permit Application
<br /> Date Received Z G 0 Vioti
<br /> $' �O tact 490 r/
<br /> � Phone Con for Permit 813
<br /> Owner's
<br /> is Name �� -�7l j Owner's Phone Number gt s 69-e) yiot i
<br /> , 1
<br /> Owner's Address
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Ads �
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<br /> Job Address * ::.
<br /> ?' r GALA— &LN Lot#
<br /> Sub Division Parcel #
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<br /> I I Bio -Hazard Waste Storage - ANNUAL I I Fumigation Tent
<br /> n Comm Exhaust Kitchen Hood /Duct c , I Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> I I Controlled Bum (� ° I I Hood Installation ' j -11 I I Emergency Generator < 30 kw q" I LP /Natural Gas - Installation (' / - /
<br /> I I Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale
<br /> Fire Protection Maintenance - ANNUAL El Places of Assembly- ANNUAL
<br /> 1Utrlyl JSemi1 f I Uther
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I ✓ I I Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ 1 1 1 Sprinkler System Installations
<br /> Hood Suppression n ❑ ❑ ❑ 1 1 1 1 Standpipes (Sprinkler Sys)
<br /> I Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> Fire Pumps I 1 Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> Flammable Application- ANNUAL 1 (1 C.00 I Valuation of Project
<br /> I Fuel Tanks
<br /> fl Other: 1 RcI.00AI ion' OF bE■t4C % Ste+ reApplAtr ,sSAC.
<br /> .. '•:aila '_,. :a., :„.g r ✓ttsman ^':.i :�,.' n.�a4;i sage r ,,, , . E ,.R`.�: ki•..a.>"a.*" sur'. rc ■e.;a ¢.€ „£�3:..i s...':M:.'dw_. rM=g0 igiat art i= ". a'w.._.i,`�u:.�.�'M=i= =,x /ekL ... ,., eZaty I
<br /> Contracto / Company AkolatI'►1 *JEG1�I@I' l LNwXILeJ 3
<br /> Signature Registered b N Fee Cunent Y / N
<br /> Address I I License # I CPs. OO O y p0
<br /> ELECTRICIAN Company
<br /> Signature Registered Y / N I Fee Current I Y / N
<br /> Address I I License #
<br /> PLUMBER Company
<br /> Signature Registered Y / N , Fee Current 1 Y / N
<br /> Address I I License # I
<br /> MECHANICAL Company
<br /> Signature Registered Y / N Fee Current 1 Y / N j
<br /> Address I License #
<br /> OTHER Company
<br /> Signature Registered Y / N I Fee Current I Y / N I
<br /> Address 1 I 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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