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aisaso-oo2o Ciry of Zephyrhills Fire Fax
<br /> Permit Application
<br /> Date Received Phone Contact for Perm
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<br /> Owner's Name f� k C� C. Owner's Phone NumbEr
<br /> Owner's Address 1��. � ,/ �� 3 3s y
<br /> Fee Simp�e Titleholder Name Titleholder Phone Number �� ��
<br /> Fee S�mpie Tdleholder Atldress 1
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<br /> Job Address • Lot #
<br /> Sub Division Parcel #
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<br /> � Bio-Hazard Waste Sforage - ANNUAL a Hazardous Material �er II or RQ Facility) ANNUAL
<br /> � Comm Exhaust Kitchen HoodlDuct � Hood �nstallation
<br /> � Controlled Bum � LPINatural Gas-Install:3tion
<br /> � Emergency Generator < 30 kw a LP/Naturat Gas-ANNUAL Sale
<br /> � Emergency Generator > 30 kw � Places of Ass�mbly :ANNUF,L
<br /> � Fire Protection Maintenance - ANNUAL � RecreaUOnal Burn
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<br /> Sprmkler � 0 ❑ ❑ � Sparklers �� j �
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<br /> Fire Alarm �❑ ❑ �� � Sprinkler System Instailations �'' �
<br /> Hood Cieaning �❑ � ❑� � Standpipes (Sprinkier Sys)
<br /> Hood Suppression �❑ ❑ O� � Torch RoofinglTar Kettte
<br /> � Fire Alarm Installation a 4Vaste Tire Storage ANNUAI
<br /> n Fire Pumps
<br /> �� Fire Works
<br /> � Ftammable Application- ANNUAL Valuation of Project
<br /> � Fuel Tanks
<br /> � Other:
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<br /> Contractor Company — "j — o �u � sp (u '�'1'pn . 1nG �
<br /> S�gnature Registered Y/ N Fee Current Y 1 N
<br /> Address 35 31 l�¢ ,�1,on� Ra�. License# E.F00004N �
<br /> ELECTRICIAN Company —�
<br /> Signature RegiStered Y/ N Fee Current Y/ N
<br /> Address License #
<br /> PLUMBER Ccmpar,y —�
<br /> S�gnature Registered Y/ N Fee Current Y/ N
<br /> Adtlress License #
<br /> M ECHAN I CAL Company
<br /> Signature Registered Y/ N Fee Current Y/ N
<br /> Address License #
<br /> OTHER Company �
<br /> Signature Registered Y/ N Fee Current Y! N
<br /> Address LIC@n5e #
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<br /> Duections
<br /> Fili 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 reqwretl (Mechanical work over 55000)
<br /> Supply two (2) sets ot drawings with applica6le documentation
<br /> Altow 10-14 days for review after submittai date. Parcel #- obtained from Propsrty Ta�c NoGce (http:l/appraiser.pascogov com)
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