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813 -780 -0020 City of Zephyrhills Fire Fax -813- 780 -0021
<br /> Permit Application
<br /> Date Received I Phone Contact for Permit
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<br /> Owner's Name ISX EGePio‘.+ 7h &5 /si► L %,.,,-c 4 Owner's Phone Number S
<br /> Owner's Address 5 8S—S— /G .5 7 20 h/l 'L•
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address I
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<br /> Job Address Lot #
<br /> Sub Division Parcel #
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<br /> n B io -Hazard Waste Storage - ANNUAL n Fumigation Tent
<br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> I - 1 Controlled Burn n Hood Installation
<br /> F - 7 Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> n Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> Ti F ire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> �Qtrlyl !Semi] Other
<br /> Sprinkler n O ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers
<br /> Hood Cleaning 7 ❑ AI ❑ I n Sprinkler System Installations
<br /> Hood Suppression © ❑ X ❑ I I n Standpipes (Sprinkler Sys)
<br /> FT F - ire Alarm Installation n Torch Roofing/Tar Kettle
<br /> Fire Pumps n Waste Tire Storage ANNUAL
<br /> n Fire Works
<br /> n Flammable Application- ANNUAL
<br /> 1 ( Valuation of Project
<br /> IT Fuel Tanks
<br /> I O ther: I
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<br /> Contractor Company
<br /> Signature Registered Y/ N j Fee Current 1 Y/ N
<br /> Address I License # I I
<br /> ELECTRICIAN Company
<br /> Signature 1 Registered Y/ N I Fee Current I Y/ N I
<br /> Address I I License #
<br /> PLUMBER Company
<br /> Signature Registered Y/ N J Fee Current I Y/ N J
<br /> Address I I License #
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N j Fee Current 1 Y/ N I
<br /> Address I I License #
<br /> OTHER Company , ot• . -g 7 ,E; e .�.• /p...s s/> 1
<br /> Signature _ Registered BUM Fee Current Ma
<br /> . Address I License # , s - G /9f f
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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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