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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 /> Owner's Name ��36y /Leo..., /t-�U.4k /+ ,,,e Pif.P.k Owner's Phone Number R-13 7s 1 //ii
<br /> Owner's Address 3J6 /-S I is....P.4f 2904 y T.
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address
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<br /> Job Address Lot #
<br /> Sub Division Parcel #
<br /> 3 : "dai G mmarmi E , , . a ,,. .i. rY" §M <", i i 't a;zr a a " ..�,8:.�:�:a'a S' .�' "
<br /> r--1 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 Burn 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 /> IUtriy) )Semis pziri Other
<br /> Sprinkler 0 ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I n Sparklers
<br /> Hood Cleaning Ell l ❑ ❑ I I n Sprinkler System Installations
<br /> Hood Suppression © ❑ fL ❑ I I n Standpipes (Sprinkler Sys)
<br /> I - 1 Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> n Fire Pumps I—I Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> I Flammable Application- ANNUAL
<br /> 1 I Valuation of Project
<br /> F - 7 Fuel Tanks
<br /> n Other: I I
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<br /> Contractor Company I
<br /> Signature Registered Y / N I Fee Current I Y / N
<br /> Address I License # I I
<br /> ELECTRICIAN Company I
<br /> Signature I Registered Y / N I Fee Current I Y/ N I
<br /> Address I License # I I
<br /> PLUMBER Company I
<br /> Signature Registered . Y/ N 1 Fee Current I Y/ N I
<br /> Address I I License # I
<br /> MECHANICAL Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N I
<br /> Address I I License # I I
<br /> ■
<br /> OTHER Company -SAC'i t/> �.ce E�vi ^./ .44c I
<br /> Signature ; 0'vl Registered LPN Fee Current I CD N I
<br /> Address) I License # J 7�1G5' a I
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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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