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813 City of Zephyrhills Fire Fax
<br /> Permit Application
<br /> Date Reczive;d Phone Contact for Permit �,�'i Q�1 Q 19 q
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<br /> Owner's Name � �� /1� Owner'S Phone Number
<br /> Owner's Address /�/ � l� r. S��lo i G P �� S • 3 3
<br /> Fee Simple Tftleholder Name Tit1eh01der Phone Numbe� �� �
<br /> Fee S�mpie Titleho�der Addre°s
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<br /> Job Address � , s� '� 0 1 � I I
<br /> , � , � s 3 `�ot # �-�
<br /> Sub Division Paz �� #
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<br /> � Bio-Hazard Waste Storage - ANNUAL a Hazardous Materiai {Tier II or RQ Facility) ANNUAL
<br /> � Comm Exhaust Kitchen HoodlDuct � Hood Installation
<br /> � Controlled Bum � LP/Natural Gas-Instaliation
<br /> � Emergency GeneraYOr < 30 kw � LP/Natural Gas-ANNUAL Sale
<br /> � Emergeney Generator> 30 kw � P!aces ofAssembly-ANNU�'.L
<br /> a Fire Protection Maintenance • ANNUAL � ReCreational Burn
<br /> � ry emi � t er
<br /> Sprinkler � ❑ ❑ ❑ � � Sparklers 1 �/ � � �
<br /> fire Alarm � � p � � ❑ � 1 !�
<br /> Sprinkler SyStem Instailations
<br /> Hood Cieaning � ❑ ❑ ❑ � � Standpipes (Spnnkler Sys)
<br /> Hood Suppression �❑ ❑ ❑� � Torch Roofing/Tar Kettle
<br /> � Fire Alarm Installation Q Waste Tire Storage ANNUAL
<br /> � Fire Pumps
<br /> Fite Works
<br /> � Flammable Application- ANNUAL Valuation of Project
<br /> � Fuel'�anks
<br /> � Other:
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<br /> Coniractor Company T� S �u �'O� n
<br /> Signature Registered Y! N Fee Current Y J N
<br /> Address 3531 l�+e ,�nQ, R�, License# EFOOO�H�I1
<br /> ELECTRICIAN Company
<br /> 5�gnature RegiStered Y/ N Fee Current Y! N �
<br /> Address License #
<br /> PL'JMBER
<br /> Company '
<br /> S�gnacure Registered Y! N Fee Current Y/ N
<br /> Adtlress
<br /> �cense #
<br /> MECHANICAL
<br /> Company �
<br /> S�gnature Registered Y/ N Fee Currant Y/ N
<br /> Address
<br /> License #
<br /> OTHER Company �—
<br /> Signature Registered Y/ N Fee Current Y/ N
<br /> Address
<br /> __.._ LiCense #
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<br /> D�recUOns: -- -- - - - --�r.�=�{��i=.:.�..�__._ �-Y�,-.�_:, :.,,_ ---- -_ -- ,
<br /> Fill out application completey.
<br /> Owner & Contr ctor sign back of applicatbn, notarized (Or, copy of signed conVact wdh owner;
<br /> If over 52500, a IVotice of Commencement is required (Mechan�cal work over $5000)
<br /> Suppiy two (2) sets of drawings with applicable documentation
<br /> Allow 10-14 days for review after submitta! date. Parcel #- obtained from Propsrty Tax Notice (http:1/appraiser.pascogov.com)
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