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<br /> aisaso-oo20 �/� �y p,.,� �� Ciry of Zephyrhills Fire Fax-813-780-002
<br /> fV 1"rvw� � ' Permit pplication
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<br /> Date Received i �� ��` �/�4- �z one Contact tor Perm __ :1'3 Q y:�. � 9� 3
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<br /> �' ` Owner's Phone Number � ' Q c�.S-S
<br /> Owner's Name �—� C W� .-
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<br /> Owner's Address ! a
<br /> Fee Simple Titleholder Name Titleholder Phone Number l3 70 � �� �
<br /> Fee Simple Titleholtler Address
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<br /> Job Address � �(� 4 i Lot #
<br /> Sub Division Parcei #
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<br /> � Bio-Hazard Waste Storage - ANNUAL � Hazardous Material (Tier 11 or RQ Facility) ANNUAL
<br /> � Comm Exhaust Kitchen Hood/Duct � Hood Installation
<br /> � Controlled Bum � LP/Natural Gas-Instaliation
<br /> � Emergency Generator < 30 kw � LP/Natural Gas-ANNUAL Sale
<br /> � Emergency Generatcr> 30 k�v � Places uf Assemblyti4NUA�
<br /> � Fire Protection Maintenance - ANNUAL � Recreational Burn
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<br /> Sprinkler � ❑ ❑ ❑ � � Sparklers �"
<br /> Fire Alarm �❑ ❑ � � Sprinkler System Instailations
<br /> Hood Cleaning � 0 ❑ ❑ � Standpipes (Sprinkler Sys)
<br /> Hood Suppression �❑ ❑ O� � Torch RoofinglTar Kettle
<br /> � Fire Alarm Installatlon a Waste Tire Storage ANNUAL
<br /> � Fire Pumps
<br /> Fire Works
<br /> � Flammable ApplicaGon- ANNUAL � Valuation of Project
<br /> � Fuel Tanks
<br /> � Othe�:
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<br /> Contractor COmpany "'�'o �}, � $ p (u ��On . {,�G
<br /> Signature Registered Y/ N Fee Current Y/ N
<br /> Address 3 5 31 1� ¢,�an ¢. Ra�. License # E, F 0000 �4y �
<br /> ELECTRICIAN Company �_
<br /> Sfgnature RegiStered �( /�I Fee Current Y/ N
<br /> Address Ucense #
<br /> Pl'JMBER ��;�yG��y
<br /> S�gnawre I Registered Y/ N Fee Current Y/ N
<br /> Address License #
<br /> MECHANICAL Company �
<br /> Signature Registered Y/ N Fee Currant Y/ N
<br /> Address License #
<br /> OTHER Company �_
<br /> Signature Registered Y/' N Fee Current Y/ N
<br /> Address LiCense #
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<br /> Fill out application completely
<br /> Owner 8 Contractor sign back of application, notarized (Or, copy of signed contract with owner)
<br /> If over 52500, a Notice of Commencement is required (MeChaniCat work over $5000}
<br /> Supply two (2) - �ts of drawings wfth appiiCable documentation
<br /> Alfow 10-14 days for review after submittal date. Parce! #- obtained from Property Tax Notice (http://appraiser pascogov.com)
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