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�is-7so-oo2o City of Zephyrhills Fire Fax-813-780-002�
<br /> Permit Application
<br /> Date Received Phone ContaCt for Permit �}.Z'� 9 y Q 19 4 3
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<br /> Owners Name ��,�*L�}/�/b '��iC� �iqNb/L C��G Owner's Phone Number C� �� �
<br /> Owner's Address �d �a� ���y ��
<br /> Fee Simple Titlehotder Name Titleholder Phone Number C� � �
<br /> Fee Simpie Trtiehoitler Atldress
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<br /> JobAddress 3� a�cY /'/��Q.y '� Lot# �
<br /> Sub Division Parcei#
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<br /> � Bio-Hazard Waste Storage-ANNUAL � Hazardous Materiai�er It or RQ Facility)ANNUAL
<br /> � Comm Exhaust Kftchen Hood/Duct � Hood Installation
<br /> � Controlled Burn � LPlNatural Gas-Instailation
<br /> � Emergency Generator<30 kw a LP/Naturei Gas-ANNUAL Sale
<br /> � Emergency Generaior>30 kw � Places of Assembly-ANNUAL
<br /> � Fire Protection Niaintenance-ANNUAL a Recraauonal Burn
<br /> r y emi �n er �
<br /> Sprinkler � ❑ ❑ � B � Sparklers n G� �
<br /> Fire Alarm � ❑ ❑ � � � Spnnkler System Insta�lations . � [v
<br /> Hood Cieaning � ❑ ❑ � � � Standpipes(Sprinkler Sys) �
<br /> Hood Suppression � ❑ ❑ ❑ � � Torch Roofing/Tar Kettie
<br /> QFire Alarm Installation � Waste Tire Storage ANNUAI
<br /> n Fire Pumps
<br /> UFire Works
<br /> � Flammabie Application•ANNUAL Valuation of Project
<br /> � Fuel Tanks
<br /> � Other:
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<br /> Contractor Company T �1 � �'1'O
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address 3 5 31 l�Q. ,�on Q. Ra�. License# E,F 0000 y 1
<br /> ELECTRICIAN Company
<br /> Signature kegistered Y/N Fee Current Y/N
<br /> Address License# `—�
<br /> PLUMBER Company
<br /> S�gnature �egisteead Y i 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:
<br /> Fill out appiication completely
<br /> Owner&ConVactor sign back of application,notarized(Or,copy of signed contract with owner)
<br /> If over$2500,a Notice of Commencement is required(Nechanical work over 55000)
<br /> Supply two(2)sets of tlraw�ngs with applicable documentation
<br /> Allow 10-1a days for review after submittal date. Parcel#-obtained from Properly Tax Notice(http:/lappraiser.pascogov com)
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