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- 813- 780 -0020 City of Zephyrhills Fire Fax -813- 780 -0021
<br /> Permit Application
<br /> Date Received I �)
<br /> Phone Contact for Permit
<br /> ,�. .. _ .�_ .�.__ .. ���� � S pa y�
<br /> Owner's Name A'1 e .Q C L4 3-U -\ Y' 1,--,r. r k_e-I Owner's Phone Number
<br /> Owners Address (\ `,r.)V-- Y 1 1 ---- C
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address I
<br /> Job Address 35 r. \ \ \ iCk Lot#
<br /> Sub Division Parcel 3 405- DI-0OO6- —G(P0
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<br /> Bio- Hazard Waste Storage - ANNUAL I I Fumigation Tent
<br /> n Comm Exhaust Kitchen Hood /Duct I I Hazardous Material (Tier 11 or RQ Facility) ANNUAL
<br /> I Controlled Bum I I Hood Installation
<br /> I Emergency Generator < 30 kw I LP /Natural Gas - Installation
<br /> 1 I Emergency Generator > 30 kw • I I LP /Natural Gas - ANNUAL Sale
<br /> I I Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL
<br /> IUtrl ( Fit11 Utner
<br /> Sprinkler n ❑ ❑ , , I Recreational Bum
<br /> Fire Alarm I] ❑ ❑ ❑ I I Sparklers ' '
<br /> Hood Cleaning �I ❑ t_-:' ❑ I I Sprinkler System Installatiof
<br /> l�
<br /> o
<br /> Hood Suppression I ❑ ❑ ❑ I I I Standpipes (Sprinkler Sy- 4 i
<br /> Ti Fire Alarm Installation I 1 Torch Roofing/Tar Kettle
<br /> H Fire Pumps I I Waste Tire Storage ANNU • .
<br /> Fire Works
<br /> 7 Flammable Application- ANNUAL ( Valuation of Project
<br /> I Fuel Tanks
<br /> E 1 Other:
<br /> Contractor ` -�° a .- s�,. �;.���_a.,-, _ . m :.�.,.�� � _..��.�. . .a. ..__ .. F�� >.;.UA_. , �_
<br /> Company
<br /> Signature Registered Y / N j Fee Current I Y/ N _I
<br /> Address I
<br /> I License # I
<br /> ELECTRICIAN
<br /> Company
<br /> Signature Registered Y/ N Fee Current 1 Y / N I
<br /> Address I
<br /> I License #
<br /> PLUMBER Company
<br /> Signature Registered Y / N I Fee Current I Y / N 1
<br /> Address I I
<br /> License #
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N I Fee Current 1 Y / N I
<br /> Address
<br /> 1 License # I
<br /> r ff
<br /> Company
<br /> OTHER S-1 i' . (' `( I
<br /> t,` N d i
<br /> Signature Registere Fee Current I Y / N1
<br /> Address I `. • , (7 G►1f1)'` W r
<br /> C
<br /> (i 3311 U License # c,, , 1
<br /> � a DLO CrL , . II (1 U 1
<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: /iappraiser.pascogov.com)
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