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813-780 -0020 City of Zephyrhills Fire Fax -813- 780 -0021
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<br /> Permit Application
<br /> Date Received I !/ J Phone Contact for Permit I
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<br /> Owner's Name litgove4447 L ✓ Owner's Phone Number I ,1 7 1 399-
<br /> Owner's Address 1 S3ea ,PJre-6-'E"7 .4 e,s4!/.I , FL-
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee SimpleTitleholder Address
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<br /> Job Address Lot #
<br /> Sub Division Parcel #
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<br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent
<br /> Pi C omm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier 11 or RQ Facility) ANNUAL
<br /> n Controlled Bum n Hood Installation
<br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> n E - mergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> FT F - ire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> IGl ram 'Semi' ' Other
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ I I n Sprinkler System Installations
<br /> Hood Suppression [X I ❑ X ❑ I I 7 Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> El Fire Pumps I I Waste Tire Storage ANNUAL
<br /> n Fire Works
<br /> n Flammable Application- ANNUAL
<br /> 1 I Valuation of Project
<br /> Ti Fuel Tanks
<br /> Q Other: I
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<br /> Contractor Company
<br /> Signature Registered Y / N . 1 Fee Current Y / N 1
<br /> Address I I License # I
<br /> ELECTRICIAN Company
<br /> Signature I Registered Y/ N I Fee Current I Y/ N I
<br /> Address I ( License #
<br /> PLUMBER Company
<br /> Signature Registered Y/ N I Fee Current I Y/ N I
<br /> Address I I License # I I
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N I Fee Current I Y / N 1
<br /> Address I License # I
<br /> OTHER Company �$tt ,7' / -i,.€ c�ay.- G G
<br /> Signature / ) -T/f Registered MUM Fee Current 1 ' N
<br /> Address) License # I ?(jopGCxie/ /mar
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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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