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y ?13-i 30-0020 City of Zephyrhills Fir•e
<br /> Fax-813-780-0021
<br /> Permit Appiication
<br /> Date Received Phone Contact for Permit
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<br /> Owner's Name � � � , Y-.. _ ...., � � ...:.: � �., ,. -- � "� .,
<br /> Owner's Phone Number
<br /> Owner's Address � � �� , 1 3 �
<br /> Fee Simple Titleholder Name � �� ��
<br /> Titleholder Phone Number
<br /> Fee Simple Titleholder Address
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<br /> Job Address � �� '�, � � r� � V � � " :`'
<br /> Lv 1J �-�t h 2 � l. N 335 , '�ot #. ��
<br /> Sub �ivisi�n
<br /> Paroel #
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<br /> azard Waste Storage - ANNUAL Q 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-Instaliation
<br /> � Emergency Generetor> 30 kw � LP/Natural Gas-ANNUAL Sale
<br /> � Fire Protection Maintenance - ANNUAL � Places of Assembiy-ANNUAL 2�
<br /> ❑ r y emi � er � „�^ u
<br /> Sprinkler �� f/1(�
<br /> � � � Recreational Bum
<br /> Fire Alartn � ❑ ❑ ❑ � � Sparklers
<br /> Hood Cleaning � � p p� � Sprinkler System Installations
<br /> Hood Suppression ❑ ❑ ❑ � � Standpipes (Sprinkler Sys)
<br /> � Fire Alarm Instailation � Torch RoofingfTar Kettle
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> � Fire Works
<br /> � Flammable Appiication- ANNUAL
<br /> � Valuation of Project
<br /> Fuel Tanks
<br /> Q Other:
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<br /> Contractor • ...�, �.._.�>_..�_,..��,�.. .s�,k�:,. ��s: �.�.w�s:�. �:.�..,. ::��._���,.__
<br /> Signature Company rj- � � � w
<br /> Registered N Fee Current Y
<br /> Address . �
<br /> License #
<br /> ELECTRICIAN ]'
<br /> Signature 'T Company
<br /> Registered Y/ N Fee Current Y/ N
<br /> Address
<br /> License #
<br /> PLUMBER
<br /> Signature Company
<br /> Registered Y/ N Fee Current Y/ N
<br /> Address
<br /> License #
<br /> MECHANICAL
<br /> Signature Company
<br /> Registered Y/ N Fee Current Y/ N
<br /> Address
<br /> License #
<br /> OTHER
<br /> Signature Company
<br /> Registered Y/ N Fee Current Y/ N
<br /> Address
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<br /> Directions: �_._ .� ... __. ,....._.,_ � ._.... ........ .�.�.a..._..�..�>�, License#
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<br /> Fill out application completely '� •--• •`"`•" ".
<br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract 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://appreiser.pascogov.com)
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