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sis-�so-oozo Ciry of Zephyrhills Fire Fax-813-780-002
<br /> � ' Permit Application
<br /> Date Received
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<br /> Phone Contact for Permit ,�'Z 4�12 1 q
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<br /> Owner's Phone Nu �{�'' � ���
<br /> Owner's Name ' 1—..9_�.[_...! L�LI
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<br /> Owner's Address �5 7 � �((� � w G Z P � �� '
<br /> Fee Simple Trtleholder Name l"itleholder Phone Nuntber L�1 ��
<br /> Fee S�mpie Titlehoider Address
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<br /> Job Address � � � � � �3 / ' � j
<br /> � Lot # u
<br /> Sub Division Parcei #
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<br /> � Bio-Hazard Waste Storage - ANNUAL � Hazardous Material (Tier it or RQ Facility) ANNUAL
<br /> � Comm Exhaust Kitchen Hood/Duct Q Hood Installation
<br /> � Con2rolled Bum � LP/Natural Gas-Instaliation
<br /> � Emergency Generator < 30 kw a LP/Naturai Gas-ANNUAL Sale
<br /> � Emergency Generator > 30 kw � P!2ces of Assambly-ANN�AI.
<br /> � Fire Protection Maintenance -ANNUAL a ReCreational Burn
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<br /> Sprinkler � ❑ ❑ ❑ � Sparklers �'
<br /> Fire Alarm �❑ ❑ �� � Sprinkler System Installations
<br /> Hood Cleaning �❑ ❑ O� � Standpipes (Sprinkler Sys)
<br /> Hood Suppression �❑ ❑ ❑� � Torch Roofing/Tar Kettle
<br /> � �ire Atarm Installation � Waste Tire Storage ANNUAL
<br /> � Fire Pumps
<br /> Fire Works
<br /> � Flammable Application- ANNUAL Valuation of Project
<br /> � Fuel Tanks
<br /> � Other:
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<br /> Contractor Company '""�" .}., ` tu �1'O „
<br /> S�gnature Registered Y/�1 Fee Current Y/ N
<br /> Address 3531 1�+¢ ��4,ane, Rd . license# �FOOOO�Iy�
<br /> ELECTRICIAN Company �
<br /> Signature RegiStered Y/ N Fee Current Y! N
<br /> Address
<br /> License #
<br /> °L'JMBER �
<br /> Company
<br /> S�gnature Registered Y/ N Fee Current Y/ N
<br /> Address LiCense # �
<br /> MECHANICAL Company '�"i
<br /> Signature I
<br /> Registered Y/ N Fee Current Y/ N
<br /> Address License �L
<br /> OTHER
<br /> Company "�'t
<br /> Signature I
<br /> Registered Y/ N Fee Current Y/ N
<br /> Address
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<br /> �cense
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<br /> Direct�ons _ -'-1_ -- --- • -- - - _ .. = -::_ _,: � .,�,;
<br /> Fill ou! application completely
<br /> Owner & ConVactor Sign back of apptication, notarized (Or, copy of signed conVact with owner)
<br /> If over S2500, a Notice of Commencement is required (MechaniCal work over 55000)
<br /> Supply two (2) sets of tlfawings with appliCBble documenletion
<br /> Allow 1 o-1a days for review after submittat date. Parcei #- obtained from Propsrty Tax Notice (http://appraiser.pascogov com)
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