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Bis-�ao-oo2o City of Zephyrhills Fire
<br /> ' Permit Application Fax-813-�80-0021
<br /> Date � �
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<br /> ._... - :.. .-: �.?'t 9y2 �99
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<br /> __ one ontact for
<br /> Owner's Phone Nu � =�� ���^~.' �^ ' _ -
<br /> Owner's Name � ' --
<br /> mber � 77 �
<br /> Owner's Address 3� a r � ���
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<br /> Fee Simple Titleholder Name � ��
<br /> Fee Simpie Titleholder AddresS Titleholder Phone Number ��
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<br /> JobAddress ' ����� L ���� - ° -,
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<br /> Sub Division Lot #
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<br /> Bio-Hazard Waste Storage - ANNUAL y ���� - �"� �""� �'� °� -'- - �- -
<br /> ❑ � Hazardous Material (Tier II or RQ Facility) qNNUAL
<br /> Comm Exhaust Kitchen Hood/Duct
<br /> ❑ Hood Instailation
<br /> Conirolled Burn �
<br /> � LP/Natural Gas-Instaliation
<br /> Emergency Generator < 30 kw a LP/Natural Gas-ANNUAL Sale
<br /> � Emergency Generator> 30 kw �
<br /> Places ofAssembly-ANNUAI
<br /> � Fire Protection Maintenance - qNNUAL �
<br /> Recreational Burn
<br /> ❑ �Y emi � er ❑
<br /> Sprinkler � � �
<br /> � Sparklers
<br /> Fire Alarm � � �,,,r ❑ //! (��^ ' /
<br /> Y° PN � Sprinkler System installations Il ,I I �/ �
<br /> Hood Cleaning ❑ � � � � ❑ ..Y[/ 1
<br /> Standpipes (Sp�nkler Sys) < < �
<br /> Hood Suppression � p � � � ❑
<br /> � Torch Roofing/Tar Kettle
<br /> Fire Alarm Installation �
<br /> � Waste Tire Storage ANNUAL
<br /> Fire Pumps
<br /> � Fire Works
<br /> � Flammabie Application- ANNUAL
<br /> � Fuel Tanks Valuation of Project
<br /> � Other:
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<br /> ontractor - .,���:,...��:.��_::_: -
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<br /> Signature Company A —�-- � � �,
<br /> Registered Y/ N Fee Current Y/ N
<br /> Address 35 31 Vi¢ �}, Rd
<br /> �icense# (�`�,� �
<br /> ELECTRICIAN
<br /> Signature Company
<br /> Registered LY / N J Fee Current Y/ N�
<br /> Address
<br /> License #
<br /> PLUMBER
<br /> Signature Company �--
<br /> Registered , Y/ PJ Fee Current Y/ N
<br /> Address
<br /> License # �
<br /> MECHANICAL
<br /> Signature Company
<br /> Registered Y/ N Fee Current Y/ N
<br /> Address
<br /> License it �_
<br /> OTNER
<br /> Signature Company
<br /> Registered Y/ PI Fee Current Y/ N
<br /> Address
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<br /> D�rections: --._...__�_ ..- � ..:.._-...:> ,
<br /> _ __... _ _ - _ _ __- _ . _ _ icense # __ �
<br /> Fill out application completely '
<br /> Owner & ConVactor 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 /> Suppty rivo (2) sets of tlrawings with applicabte documentation
<br /> Allow 10-14 days for review after submittal date. Parcei #- obtained from Property Tax Notice (http://appraiser.pascogov com)
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