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a�saso-oo2o City of Zephyrhills Fire Fax-sisaso-ooz�
<br /> Permit Application
<br /> Date Received �—_� Phone Contact for Permit �,�'3 9 y 2 1 q q 3
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<br /> Owner's Name f.� ` Owner's Phone Number ����
<br /> Owner's Address y A i / j S�
<br /> Fee Simple Titleholder Name Titleholder Phone Number �� ��
<br /> Pee Simpie THleholtler Address
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<br /> Job Address Q F G Z � $ �• 3�� yQ Lot # �
<br /> Sub Division ParCei tt
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<br /> � Bio-Hazard Waste Storage - ANNUAL a Hazardous Material (Tier II or RQ Faciliry) ANNUAL
<br /> � Comm Exhaust Kitchen HoodlDuct � liood Instaliation
<br /> � Controlled Burn � LP/Natural Gas-Installation
<br /> � Emergency Generator < 30 kw � LP/Natural Gas-ANNUAL Sale
<br /> � Emergenc:v Gererator> 30 kw Q Places otAssembly-ANNUAI
<br /> � Fire Protection Maintenance - ANNUAL a Recreational Burn
<br /> ry emi �n er �
<br /> Sprinkler � ❑ ❑ ❑ B � Sparklers f �
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<br /> Fire Alarm �❑ ❑ SfNi Sprinkier System Installations �
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<br /> Hood Cleaning � ❑ ❑ �� � Standpipes (Sprinkler Sys)
<br /> Hood Suppression �❑ ❑ ❑� � Torch Roofing/Tar Kettle
<br /> � Fire Alarm Instaliation � Waste Tire Storege ANNUAL
<br /> � Fire Pumps
<br /> Fire Works
<br /> � Flammabie ApplicaGon- ANNUAL ValuatiQn of Project
<br /> � Fuel Tanks
<br /> �] Other:
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<br /> concractor company To -i�a 1 3c tu �'or� . tnc„
<br /> Signature Registered Y/ N Fee Current Y 1 N
<br /> Address 3531 1�+e ,�4-ane. Rati. License# E,FO000 �II
<br /> ELECTRICIAN Company —�
<br /> Signature RegiStered Y/ N Fee Current Y/ N
<br /> Address License #
<br /> PLUMBER � Company �
<br /> S�gnature Registered Y/ N Fee Current Y/ N
<br /> address License #
<br /> MECHANICAL Company �—
<br /> Signature Registered Y/ N Fee Current Y/ N
<br /> Address License #
<br /> OTHER Company
<br /> S�gnature Registered Y/ N Fee Current Y/ N
<br /> Address
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<br /> icense
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<br /> Directions: �.. . -:� �-� .�-�-:T__..�.._�.=.y.,.�_x_
<br /> FiA out app�ication completely
<br /> Ownet & Contraetor stgn back of applicaLOn, notarized (Or, copy of si5red contract with owner)
<br /> If over 52500, a Notice of Commencement is reqwred (MechaniC21 work ove; 55000'�
<br /> Supply two (2) sets of drawings with applicabie documentation
<br /> Al�ow 10-14 days for review after submittal date. Parcei #- ootained !ram Properry 1"ax Notice (http://appraiser pascogov.com)
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