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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021
<br /> Permit Application
<br /> Date Receiveu► L � ��/ Phone Contact for Permit � ��'Q �7
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<br /> Owner's Name �/Ci�i1/a y � �� ����� Owner's Phone Number ��3 7�3 �p ��J Y
<br /> Owner's Address /�jl�' V`fjl � �!� Lj �� �`, 33�
<br /> Fee Simple Titleholder Name Titleholder Phone Number �� � I I
<br /> Fee Simple Titleholder Address �
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<br /> '�i':«;���T'�i�;M �;� �'`�u 3 � "��
<br /> Job Address ��
<br /> Lot #
<br /> Sub Division Parcel #
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<br /> Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent
<br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> � Controlled Burn � Hood Installation
<br /> � Emergency Generator < 30 kw � LP/Natural Gas-Installation
<br /> � Emergency Generator > 30 kw � LPlNatural Gas-ANNUAL Sale
<br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL /� Q�
<br /> tr y emi �n t er ❑ ,�/� y�
<br /> Sprinkler ❑ p p /(X �
<br /> � Recreational Burn '.� � �
<br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers
<br /> Hood Cleaning � p ❑ ❑� � Sprinkler System Installations
<br /> Hood Suppression � ❑ � ❑ � � Standpipes (Sprinkler Sys)
<br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> � Fire Works
<br /> � Flammable Application- ANNUAL Valuation of Project
<br /> � Fuel Tanks
<br /> Other �r ittsidh A iljRE � j �tu L
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<br /> C ontractor . ., . ° ,_. � . ,� .°<3 . �.�. .�,� , � �': �•. �°a.� .,�,.
<br /> Company iitst �
<br /> Signature N ��
<br /> Registered Y/ Fee Current Y/ N
<br /> Address
<br /> License #
<br /> ELECTRICIAN
<br /> Company
<br /> Signature Registered Y/ N Fee Current Y/ N
<br /> Address
<br /> License #
<br /> PLUMBER
<br /> Company
<br /> Signature Registered Y/ N Fee Current Y/ N
<br /> Address
<br /> License #
<br /> MECHANICAL
<br /> Signature
<br /> Company
<br /> Registered Y/ N Fee Current Y/ N
<br /> Address
<br /> License #
<br /> OTHER
<br /> Signature
<br /> Company
<br /> Registered Y/ N Fee Current Y/ N
<br /> Address
<br /> x. . License #
<br /> Directions: 1
<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 htt //a
<br /> ( p: ppraiser.pascogov com)
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