10-11303 - Laserfiche WebLink

Browse Search

x813 -780 -0020 City of Zephyrhills Fire Fax -813 -780 -0021 Permit Application Date Received I 1 Phone Contact for Permit I 11 I .I Owner's Name F.-/s // 27.4 1 Owner's Phone Number IP /2 11 1172007 Owner's Address 1.,522,S0 L 2L az z y,-)4l/ /LL Fee Simple Titleholder Name I Titleholder Phone Number I I Fee Simple Titleholder Address I Job Address I Lot # Sub Division I Parcel # I I 11 Bio-Hazard Waste Storage - ANNUAL n Fumigation Tent a Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier II or RC) Facility) ANNUAL I Controlled Bum I Hood Installation I — ) Emergency Generator < 30 kw n LP /Natural Gas - Installation E l Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale n Fire Protection Maintenance - ANNUAL El Places of Assembly- ANNUAL ni E ES"Wil UM Other Sprinkler 0 ❑ ❑ ❑ I Recreational Bum Fire Alarm El ❑ ❑ ❑ I I n Sparklers Hood Cleaning 0 ❑ ❑ ❑ I 1 7 Sprinkler System Installations Hood Suppression Z ❑ pt, ❑ I 1 n Standpipes (Sprinkler Sys) I7 Fire Alarm Installation I---I Torch Roofingfrar Kettle 1---1 Fire Pumps El Waste Tire Storage ANNUAL El Fire Works ri Flammable Application- ANNUAL I I Valuation of Project El Fuel Tanks Q Other: I Contractor Company I Signature Registered Y/ N I Fee Current I Y/ N J Address I I License # I I ELECTRICIAN Company I Signature I Registered Y/ N ] Fee Current I Y/ N Address I License # 1 PLUMBER Company I Signature Registered Y/ N 1 Fee Current 1 Y/ N J Address I I License # I I MECHANICAL Company I Signature Registered Y/ N 1 Fee Current I Y/ N Address I I License # 1 I OTHER Ovo /rii' 6.- r. i 7 L G C Signature Registered eaR11111 Fee Current Waal Address I I License # 1 28-j,0 - g64:2S/,f94(� I Directions: Fill out application completely. Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) If over $2500, a Notice of Commencement is required (Mechanical work over $5000) Supply two (2) sets of drawings with applicable documentation Allow 10 -14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com)