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813 -780 -0020 City of Zephyrhills Fire Fax -813 -780 -0021
<br /> Permit Application
<br /> Date Received _ Phone Contact for Permit
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<br /> wit
<br /> x, n,.:r1•A ns..a,*s.s2�+H.....kar...S... ;`.�....... »,..c%......• __s,»_ .... Owner's Name I Ze &L/ /' Alos4,,afe 26.4, .x* /98- Owner's Phone Number I V ) 74 ?3 vO 1
<br /> Owner's Address clos /d S><tE"7 Ze∎ rr4//S "Z
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address I I
<br /> Lot #
<br /> Job Address
<br /> Sub Division Parcel #
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<br /> El Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent
<br /> I 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 /> n 1Qtrlyl ISemil frilI
<br /> Sprinkler ❑ ❑ ❑ Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ ❑ Sparklers
<br /> Hood Cleaning � ❑ � Sprinkler System Installations
<br /> I t
<br /> Hood Suppression © ❑ 2 ❑ I 1 n Standpipes (Sprinkler Sys)
<br /> I Fire Alarm Installation n Torch RoofingfTar Kettle
<br /> n Fire Pumps n Waste Tire Storage ANNUAL
<br /> I Fire Works I
<br /> n Flammable Application- ANNUAL Valuation of Project
<br /> Ti Fuel Tanks
<br /> n Other: I
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<br /> Contractor Company 1
<br /> Signature Registered Y/ N I Fee Current I Y/ N I
<br /> Address I ( License # I
<br /> ELECTRICIAN Company 1
<br /> Signature 1 Registered Y/ N 1 Fee Current I Y/ N I
<br /> Address I I License # I
<br /> PLUMBER Company 1
<br /> Signature Registered _ Y/ N 1 Fee Current I Y/ N I
<br /> Address 1 I License # I (
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N 1 Fee Current 1 Y/ N I
<br /> Address 1 I License # ( I
<br /> OTHER . Company .e r /> ,Lire Eat i . 1 � L C I
<br /> Signature ;�' - Registered (r N 1 Fee Current N
<br /> Address I j License # 6
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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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