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813- 780 -0020 City of.Zephyrhills Fire fr /66976
<br /> Fax- 813 780 -0021
<br /> Permit Application
<br /> Date Received 1 f 2I ( ,O I Phone Contact Co
<br /> act for Permit I fifl3 13,3S 17313 1
<br /> Owner's Name I G„,t,Q_ er CL-i PS Owner's Phone Number 1 I I I
<br /> Owner's Address '7 7 4 0 ,G /IA- a c.tp) , 6pdlawF Z'cP 9
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address I
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<br /> Job Address 7 .74 D G e.c. d Gv0 ^ maw.Altoor NQ 8 " ^ GA c.[4 PS
<br /> Lot #
<br /> Sub Division ?.p itilv. GoI+Zfri.rN S Parcel #
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<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 /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> I E mergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> IQtriyI !Semi] lam Other
<br /> Sprinkler ❑ ❑ ❑ I Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I I I I Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ 1 ( Sprinkler System Installations
<br /> Hood Suppression 0 ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> n Fire Pumps n Waste Tire Storage ANNUAL
<br /> n F - ire Works
<br /> n Flammable Application- ANNUAL I (1 ?-1J0 I Valuation of Project
<br /> n Fuel Tanks
<br /> n O ther. I
<br /> .n .°""dma°'g*€:. lawags «« .:., m : .: .».;° .., , ,fix -�.: '° ,. ; x " •y �• ° _.:,: .ZY. ZAMMir "5a'k.f?3" € leaffi,-� .... „e.: µ •.a• L:,�tx•za ""r`�,`" ' I
<br /> Contractor Company Cl/A S Go ..1 S7M
<br /> 2L4 x'-,5 3./c.
<br /> Signature P' Registered LAZE Fee Current e
<br /> Address I S3° 4 S VrA <.oM,tR - ti[Q p, ,{ o 37410 License # D oO 9
<br /> ELECTRICIAN Company
<br /> Signature I Registered Y / N I Fee Current I Y/ N
<br /> Address I
<br /> License #
<br /> PLUMBER Company
<br /> • Signature Registered Y/ N J Fee Current I Y / N I
<br /> Address I I License #
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N I Fee Current I Y / N I
<br /> Address I I License* I
<br /> OTHER Company
<br /> Signature Registered Y/ N ,I Fee Current I Y/ N I
<br /> Address .: I License # J
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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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