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813 - 780 -0020 City of Zephyrhills Fire Fax - 813- 780 -0021
<br /> t. Permit Application
<br /> Date Received Phone Contact for Permit I 1
<br /> Owner's Name Aks T CO Ale-Apes P-v ‘✓Zgee Owner's Phone Number $13 17t'3 I , 7k. ('14
<br /> µ A
<br /> Owner's Address ZF'/gj/$ /,s` 4 v� Z /4 _e . "!
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address 1
<br /> Job Address Lot #
<br /> Sub Division Parcel #
<br /> .....t.5* um,`. r ': a mkot. m , ,..... „ • rte 'x '
<br /> �,°� ' °�Y�.. -. E..; �?�� .:a§'n;2�8z�<�a�a"°:�+..�"°. '.a*`��ktwisomi?...6w�_,::�msuca.=.3. an'. �:. 35.,4:.s3E4A-"ar,::i.g.,' -,
<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 /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly - ANNUAL
<br /> IQtrlyi rs7--nri Other
<br /> Sprinkler ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ 1 I n Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ 1 n Sprinkler System Installations
<br /> Hood Suppression ® ❑ X ❑ ( ( n Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> El Fire Pumps n Waste Tire Storage ANNUAL
<br /> n Fire Works
<br /> n Flammable Application- ANNUAL I 1 Valuation of Project
<br /> FT Fuel Tanks
<br /> n Other: 1
<br /> .. : : %lat T." IMIt..a; MErg .I. °n' ra, : - A> : '. , . a : WATFA : s a C,'':` .»."ria .s "»".z: MUEC xt.:a> a -'tom' ." si,.a' 6. .... Kenktj nMEO Atnra:',
<br /> Contractor Company
<br /> Signature Registered Y/ N j Fee Current I Y / N I
<br /> Address I ( License # I
<br /> ELECTRICIAN Company I
<br /> Signature I Registered Y/ N I Fee Current I Y/ N
<br /> Address 1 ( License #
<br /> PLUMBER Company
<br /> Signature Registered Y/ N Fee Current 1 Y/ N I
<br /> Address 1 I License # I
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N - I Fee Current 1 Y / N I
<br /> Address I
<br /> 1 License # I
<br /> OTHER Company •pe ... -- d o r
<br /> Signature 6610/) Registered raga. Fee Current «m
<br /> Address J License # G -' /
<br /> . Directions:
<br /> 1 . •" ' ux,,,, aaa _,,,. .,x,a,,A z� •- �:€: E, r: s.,. wk,« , wad.. >w..:t:.Wi aaz ,,,,,,, ,.�.,..,a 4.1, �:: ' ,:,a ar ; a :�, ,,,,,,,, ;: x_ , ^ :.�C'n.t 'a aP' ., Y'
<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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