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s��-�SO-oo2o Ciry of Zephyrhills Fire Fax-813-780-0021
<br /> Pertnit Application �
<br /> Date Received Phone Contact for Pertnit 9�! / Sv�7 �U3
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<br /> Ownet's Name- GO `�� .S f�}"L L� / Owner's Phone Number
<br /> Owner's Address f/
<br /> Fee Simple Titleholder Name Titleholder Phone Number �� �
<br /> Fee Simple Titleholder Address
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<br /> Job Address c7 ��-+� � ��-'1- - �a UiYc- a�✓� ��Y2�Fi�c- S �L Lot # �
<br /> Sub Division Parcel #
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<br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent
<br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier 11 or RQ Facility) ANNUAL
<br /> � Controlled Bum � Hood Installation � L � �
<br /> a Emergency Generator < 30 kw � LP/Natural Gas-Installation �.f" �
<br /> � Emergency Generator> 30 kw � LP/Natural Gas-ANNUAL Sale .�
<br /> � Fire Protection Maintenance - ANNUAL a Places of Assembly-ANNUAL
<br /> �y emi �n er
<br /> Sprinkler � ❑ ❑ ❑ � Recreational Bum
<br /> Fire Alarm � ❑ ❑ ❑ � Sparklers �
<br /> Hood Cleaning �❑ ❑ ❑� SprinklerSystem Installa ons ����L�,��w�
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<br /> Hood Suppression � ❑ ❑ � � Standpipes (Sprinkler Sys) - ----
<br /> a Fire Alartn I�stallation � Torch Roofinglfar Kettle
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> � Fire Works
<br /> � Flammable Application- ANNUAL �� Valuation of Project
<br /> � Fuel Tanks
<br /> Q Other. .v-y,A,,L_ tJ�s.[. �.[. .r-- ..� �.t-p t-�.�6. j��
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<br /> Contractor � Company ft-y�o,rL �t.� �,wTE'�T.v�v
<br /> Signature Registered Y/ N Fee Current Y/ N
<br /> Address �/��S �/'r' E 5 T .9ti r��rra iL 3'�a License #
<br /> ELECTRICIAN Company
<br /> Signature � Registered Y/ N Fee Current Y/ N
<br /> Address License #
<br /> PLUMBER Company
<br /> Signature Registered Y/ N Fee Current Y/ N
<br /> Address License #
<br /> MECHANICA 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 License #
<br /> Directions: .. .. • .. .,. - . ,. . . .... .. . ..
<br /> Fill out application completely.
<br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contrect with owner)
<br /> If over $2500, a Notice of Commencement is required (Mechanical work over $5000)
<br /> Supply two (2) sets of drawings with applicable documentation
<br /> Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http://appraiser.pascogov.com)
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