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813-7SO-oo2o City of Zephyrhills Fire Fax-813-780-0021
<br /> , - • . Permit Application
<br /> Date Received / Phone Contact for Permit P �� 3 2 j��
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<br /> Owner's Name � �,;1 �`"�Ei�y � S Owners Phone Number � l �-/ `,� � j j�
<br /> Owner's Address
<br /> Fee Simple Titleholder Name Titleholder Phone Number �� ���
<br /> Fee Simple Titleholder Address
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<br /> Job Address � 1 �j O �� L I� LV� . �����-IZ jd i �.�,� � L '3 3"��j Z Lot # �
<br /> Sub Division Paroel #
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<br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent
<br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> � Controlled Bum � Hood Installation
<br /> � Emergency Generator < 30 kw � LP/Natural Gas-Installation
<br /> � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale
<br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL �
<br /> � emi �n er / � 3 �
<br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum � I
<br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers
<br /> Hood Cleaning � � ❑ ❑ � a Sprinkler System Installations � �j� �
<br /> ❑ � ❑ V
<br /> Hood Suppression ❑ ❑ ❑ Standpipes (Sprinkler Sys)
<br /> � Fire Alarm Installation � Toroh Roofinglfar Kettle
<br /> a Fire Pumps � Waste Tire Storage ANNUAL
<br /> � Fire Works
<br /> � Flammable Application- ANNUAL Valuation of Project
<br /> Fuel Tanks
<br /> Q Other:
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<br /> COfItPdCtOf .
<br /> Signature _ Company fJ•��'j �,� ��2 S`En.y�C�e [,L
<br /> Registered Y/ N Fee Current Y/ N
<br /> Address O �-( � �,u FS G (;� "Y 335'y� 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 /> MECHANICAL 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 #
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<br /> Directions: . , . .. ......�. ,� .,.„,._ . . .�.. »�,. , .�. . ,. , . :�.. - � . . _ . .. _ . .� _....... �. .._M . ,... . . . , . . .....�.
<br /> Fill out application completely.
<br /> Owner 8 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 drewings 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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