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sisaso-oo2o City of Zephyrhills Fire Fax
<br /> ' . Permit Application
<br /> Date Received � Phone Contact for Permit �,� �l Q�) :t � 9 q 3
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<br /> Owner's Name mber �� � �
<br /> Owner'sAddress ���� /L ✓ � �'P � � pl
<br /> Fee S�mple Titteholder Name Titleholder Phone Number �� �
<br /> Fee S�mple TdlehoiqerAddress
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<br /> Job Address tot � �
<br /> Sub Division Parcel #
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<br /> � Bio-Hazard Waste Storage - ANNUAL a Hazardous Material �er il or RQ Facility) ANNUAL
<br /> � Comm Exhaust Kitchen Hood/Duct � Nood Instaliation
<br /> � Controlled Bum � LPlNatural Gas-Instatia6on
<br /> � Emergenq GeneraTor < 30 kw a LP/Natural Gas-ANNUAL Sale
<br /> � Emergency Generator > 30 kw � Pla:xs of AsSembly-ANNUAL
<br /> a Fire Protection Maintenance - ANNUAL a ReCreational Burrt
<br /> t y emi � er � �
<br /> Spnnkler � ❑ ❑ ❑ B � Sparklers TI� I�� 3
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<br /> Fire Alarm �❑ � ❑� � Sprinkler System Installations
<br /> Hood Cieanin9 �� � �� � Standpipes (Sprinkler Sys)
<br /> Hood Suppression �❑ ❑ ❑� � Torch Roofing/Tar Kettie
<br /> � Fire Alarrn Installation a Waste Tire Storage ANNUAL
<br /> n Fire Pumps
<br /> U Fire works
<br /> � Flammable ApplicaGon- ANNUAL �_ � Valuation af Project
<br /> Fuei Tanks
<br /> � Other:
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<br /> Contractor Company '""�"' .}, � �u .4.�'O n
<br /> Signature Registered Y/ N Fee Current Y 1 N
<br /> Address 3531 l�+e ,�1,one Ra1 License# E.F0000�141
<br /> ELECTRICIAN Company �
<br /> Signature RegiStered Y/ 1�) Fee Current Y/ N
<br /> Address
<br /> License #
<br /> PLUMBER Company -�
<br /> S�gnawre � Registered Y!(�" Fee Curcent Y/ N
<br /> AdOress
<br /> License #
<br /> MECHANICAL COmpany
<br /> Sgnature Registered Y/ N Fee Currant Y/ N
<br /> Address
<br /> License #
<br /> OTHER
<br /> Company
<br /> Signature Registered Y/ n) Fee Current Y/ N
<br /> Address License #
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<br /> Fill out applfcation completely
<br /> Owner & ConVactor sfgn back of appllcation, notarized (Or, copy of signed conVact with owner}
<br /> If over 52500, 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 Propsrty Tax Notice (http:/lappraiser pascogov com)
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