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813.780 -0020 City of.Zephyrhills Fire Fax -813 -780 -0021
<br /> f Permit Application
<br /> Date Received 1 1/ / 0 - /0 Phone Contact for Permit
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<br /> Owner's Name J /V L S / rr L ! G✓f j7 • \ S Aj d ✓L/ / 4 CA Owners Phone Number
<br /> Owners Address 0 1 Z S litf4
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple - Titleholder Address
<br /> Job Address Lot#
<br /> Sub Division Parcel #
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<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 /> Emergency Generator < 30 kw n LP /Natural Gas - Installation 7 ,--"
<br /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL le
<br /> In Fire Protection Maintenance - ANNUAL n Places of Assembly -A UAL
<br /> 1Qtrlyl 'Semi' OM Other
<br /> Sprinkler ❑ ❑ n Recreational Bum 1
<br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ I n Sprinkler System Installations
<br /> Hood Suppression 0 ❑ ❑ ❑ 1 1 1 1 Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> n Fire Pumps n Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> 7 Flammable Application- ANNUAL ` ( Valuation of Project
<br /> n Fuel Tanks
<br /> El Other.
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<br /> Contractor 'r Company
<br /> Signature Registered Y / N 1 Fee Current I Y / N
<br /> Address I I License #
<br /> ELECTRICIAN Company
<br /> Signature l Registered Y/ N J Fee Current Y/ N
<br /> Address f License #
<br /> PLUMBER Company
<br /> Signature Registered Y/ N ] Fee Current I Y/ N I
<br /> Address 1 I License #
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N Fee Current I Y/ N
<br /> Address I I License # I
<br /> OTHER Company
<br /> Signature Registered Y/ N J Fee Current I Y/ N
<br /> Address I ,.,_ License #
<br /> Directions:
<br /> •
<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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