|
aisaao-oo2o City of Zephyrhills Fire Fax-813-�BO-0021
<br /> Permit Application
<br /> Date Received �
<br /> . _..,..,.,,-!!--- ..� :�,�.. ,,.,"��:�,�, _-. _: _-�::::_ - .. Phone ContaCt for Permit .� �l 44 Q I q
<br /> _._,__..,,_ . _.�. ...._- _:;> ,.:_:-,...:_�--_ -
<br /> . .. ..' ' . -'.. ' ' -.. ._. - _ _' -.,=�._ , ,._. .:s,_:_: � - = - - - �`i `� r
<br /> ...._. ,�.-r.-o-�:.. � �..,....>.;:'Q.,. __
<br /> ... , _. _. ._".""3,.�:.: �' .ssxp�_ __ __ •S. . ..� "'_ .
<br /> . . . ." _ '_r:.._ v...�r_�.....,��..._. .._ ....... .......
<br /> Owner's Name - ��/ ,� Owner's Phone Number �� �
<br /> t��..!
<br /> Owner's Address � � a � S 1' +- ' 1>
<br /> r� d >
<br /> Fee Simple Titleholder Name Titleholder Phone Number �l � •�(�
<br /> Fee S�mpie Titleholder Address
<br /> �.:.._ .:,_,_„ ._,. .__ ..._._
<br /> ,._.-�,.. -:._. �::. - ..w�� ..--,...,:.:_.�.
<br /> ._ ,a,,._....
<br /> � ._ ._. ..�.,.. , �__._... _ : .�.. _ ..:_.,.
<br /> -,.„._,�,_.,.._"_:-..�::-:_t � ;-":.-. �._..,-... -..�_.
<br /> a_z.__ � za. ��. , ___ ...,,.,, �..: . . _.ti - --
<br /> --
<br /> . .,..... __,_.. z=�.-„ . T_zu.+=�.'r'.4ai�wYs�� ��.--s.e �.�.._,_.. .... �
<br /> - - =�;�'_'^- - .. - : �_.
<br /> Job Address Lot # �
<br /> Sub Division
<br /> _.. ... � _._...._..
<br /> Parcel #
<br /> .._ .::. .:. ___._'sex_:i+iue.v�iv-�c'ie..':-v''c�a�i-:4�.u.�.6::�s=-=*.v:.F_%i "i:i5':�r';.._.._.i_y " r� '
<br /> _ . . . . , ' S '_, � �'.:..'G_'':_'.__"""_.
<br /> � Bio-Hazard Waste Storage - ANNUAL a Hazardous Material �er II or RQ Facility) ANNUAL
<br /> � Comm Exhaust Kitchen Hood/Duct � Hood �nstaliation
<br /> � Controlled Burn � LP/Natural Gas-Instaliation
<br /> � Emergency Generator < 30 kw � LP/Natural Gas-ANNUAL Sale
<br /> � Emergency Generator > 30 kw a Places of Assembly-ANNUAL
<br /> � Fire Protection Maintenance -ANNUAL � RecreaUOnal Burn
<br /> ry emi � er ' ��
<br /> Sprinkler � ❑ ❑ � � � Sparklers � `�
<br /> Fire Alarm � ❑ � � � ❑ �
<br /> Sprinkler Systam Installations
<br /> Hood Cleaning �❑ ❑ p� � Standpipes (Sprinkler Sys)
<br /> Hood Suppression � ❑ ❑ ❑� � 7orch RoofinglT'ar Kettle
<br /> � Fire Alarm Installation Q Waste Tire Storage ANNUAL
<br /> � Fire Pumps
<br /> Fire Works
<br /> � Flammable Application- ANNUAL
<br /> a Valuation of Project
<br /> Fuel Tanks
<br /> � Other:
<br /> - �.: _. _. .� ,- r.-, __..::_�.:,_...: ;_ _.:. : -
<br /> -. .,..,..�.. ... . .._.._._�..��W�-_.__�: _:.��:----..:.,;_ .�.,�.::._ ;.� :,__��n,-=�:�•_= �.--� : ----. -
<br /> _���-,-"` _,...e� ��:=��_.�.:��-�F�-..�.__ .
<br /> �����_� � :��_=:�..�...:�: __.
<br /> Contractor -
<br /> Company —�^ � 1 ( �'o „�
<br /> Signature Registered Y/ N Fee Current Y/ N
<br /> Address 35 31 l�e ,}� Rd, License# E.FO000 �) !
<br /> ELECTRICIAN
<br /> Company
<br /> S�gnature Registered Y/ N Fee Current Y/ N
<br /> Address License # �—
<br /> PLUMBER
<br /> S�gnat�re
<br /> Company �
<br /> Registered Y/ N Fee Current Y/ N
<br /> Address
<br /> License #
<br /> MECHANICAL
<br /> Company �
<br /> Signature Registered Y/ N Fee Cunent Y/ N
<br /> Address
<br /> License #
<br /> OTHER
<br /> Company
<br /> Signature Registered Y/ N Fee Current Y/ N
<br /> Address
<br /> ,..... _ .__._._. .
<br /> _.:.: _ ._.: „ _:::_.2.�_-;�e,�:� �-�� _. .
<br /> _._.. __..�... :_.,_ ,_....--
<br /> .
<br /> Directions - _�._--_, :._._ _. :.. � - • -_.�.:c' .-_.:' -_-..:;,�-.w:=�=:.Se�-..'__-----��.,�. ...-- _.._._._._.. - - - �
<br /> Fill out application completely
<br /> Owner & ConVactor sign back of application, notarized (Or, copy of signed contract with owner)
<br /> If over 325Q0, a Notice of Commencement is required (Mechanical work ov�r 55000)
<br /> Supply two (2) sets of drawings with applicable documentation
<br /> Aliow 10-14 days for review after submittal date. Parcel #- obtained from Property Ta�c Notce (http:l/appraiser.pascogov com)
<br />
|