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s�saao-oo2o City of Zephyrhills Fire Fax-813-780-002 �
<br /> Permit Application
<br /> � Phone Contact for Permit �,� Z 9 y�. ► 9 4 3
<br /> Date Received _ _
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<br /> Ownzr's Name P � rt/ � Owner's Phone Number
<br /> Owner's Address 3 � ��C k/ �° �� s'
<br /> Fe? S�mple Titleholder Name Titlehoider Phone Number +�� ��
<br /> Fee S�mpie Titleholder Address
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<br /> Job Address �/"l i � G� �n/ i � S Y Lot #
<br /> Sub Division Parcel #
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<br /> � Bio-Hazard Waste Storage - ANNUAL � Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> � Comm Exhaust Kitchen Hood/Duct Q Hood tnstailation
<br /> � ControAed Bum � LP/Natural Gas-Installation
<br /> � Emergency Generator < 30 kw � LP/Naturai Gas-ANNUAL Sale
<br /> � Emergency Generator > 30 !av C Piaces of Assembly-F�NNUAL
<br /> � Fire Protection Maintenance - ANNUAL � ReCreational Burn �
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<br /> Sprinkler � ❑ O ❑ � Sparklers Z V Cl
<br /> Fire Alarm �❑ ❑ �� � Sprinkier System Installations 7
<br /> Hood Cieaning � O ❑ ❑� � Standpipes (Spnnkler Sys)
<br /> Hood Suppression �❑ ❑ O� � Torch Roofing/Tar Kettle
<br /> � Fire Aiarm Instaliatlon � Waste Tire Sto2ge ANNUAL
<br /> � Fire Pumps
<br /> Fire Works
<br /> � Flammable App�ication- ANNUAL � Valuation of Project
<br /> � Fuel Tanks
<br /> � Other:
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<br /> Contractor Company T�,ea S �u �'O n
<br /> Signature Registered Y/ N Fee Current Y/ N
<br /> Address 3 5 31 1� ¢,�I,en � Rc�. License # E. F 0000 �f N�
<br /> ELECTRICIAN Company -�
<br /> S�gnature Registered Y/ N Fee Current Y! N
<br /> Address License #
<br /> PLJMBER Company �
<br /> S�gnature ( Registered Y I N Fee Current Y/ N
<br /> Adtlress 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 /> DirecLOns:
<br /> Fill ou! application completely
<br /> Owner & ConVactor sign back of application, notarized (Or, copy of signed conVact with owner)
<br /> If over 52500, > IVotice of Commencement is required (MeChaniCal work over 55000)
<br /> Supply iwo (2) sets of drawfngs with applicable documentation
<br /> Allow 10-�4 days for review after submittal date. Parce( #- obtained from PropsRy Tax Notice (http:l/appraiser pascogov.com)
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