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a�saso-oo2o City of Zephyrhills Fire Fax-613-780-60z� f
<br /> w Permit Application
<br /> Date Received Phone Contact for Permit �,Q� Q�l Q �9 q 3
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<br /> Owner's Name ryJklG^f3L(� liJT f����}�l L Owner's Phone Number �/�j �4�� a7Q�
<br /> Owner's Adtlress �7�fJ Q� �/J�,�r/-�y.ST '� y �,��'l��,L�/�(C(S u 3�s�a
<br /> Fee Simple Tftleholder Name Titleholder Phone Number �-1 � ��
<br /> Fee S�rrpie Titleholder AddresS
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<br /> JobAddress �J��(�J� /l���r("�y5/ ��J-Y ��,(��YQ/-fCLLS �L ✓��`�U Lot# �
<br /> Sub Division Parcel#
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<br /> � Bio-Hazard Waste Storage-ANNUAL � Hazardous Material(Tier II or RQ Facilit,y)ANNUAL
<br /> � Comm Exhaust K;tchen Hood/Duct Q Hood Instailation
<br /> � Controlled Bum � LPINatural Gas-Installation
<br /> � Emergency Generator<30 kw � LP/Natural Gas-ANNUAL Sale
<br /> � Emergency Generator>30 kw Q Plac�s of Assembly-ANNUAL
<br /> � Fire Protection Maintenance-ANNUAL � ReCreational Burrt .
<br /> t y em� �n t er � � (�/
<br /> Sprinkler � ❑ ❑ ❑ � � Sparklers " � �
<br /> Fire Alarm � ❑ ❑ � � � Sprinkler System Instailations � (
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<br /> Hood Cieaning � ❑ ❑ O � � Standpipes(Sprinkler:iys)
<br /> Hood Suppression � ❑ ❑ ❑ � � Torch Roofing/Tar Kettle
<br /> � Fire Alarm installadon a Waste 7ire Storoge ANNUAL
<br /> � Fire Pumps
<br /> Fire Works
<br /> � Flammable Applicatio�-ANNUAL �— � Valuation of Project
<br /> Fuel Tanks
<br /> �] Other:
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<br /> Contractor Company '""(-' �},G� (u�'0�1 . {r�G
<br /> Signature Registered Y/(�I Fee Current Y I N
<br /> Address 3531 1�¢ ��one. Ra�. License# EFOODOi{�11
<br /> ELECTRICIAN Company —�
<br /> Sfgnature Registered Y/�I Fee Current Y/N
<br /> Address
<br /> License#
<br /> PLJMBER � Company —�
<br /> S�gnature ( Registered Y/N Fee Current Y!N
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<br /> Address License# �i —�
<br /> MECHANICAL COmpany
<br /> Signature Registered Y/N Pee Currant Y/N
<br /> Address
<br /> Lice�ise#
<br /> OTHER
<br /> Company
<br /> Signature Registered Y/�I Fee Current Y!N
<br /> Address
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<br /> Fill out appllcation completely
<br /> Owner&ConVactor sign back of appllcation,notarized(Or,copy of sgned contract with ownerj
<br /> If over S2500,a No[cce of Commencement is reqwreo(MechaniCai work over 55000)
<br /> Supply two(2)sets of drawings with appliCable documentation
<br /> Allow 10-14 days for revfew after submittai date. Parcel#-obtained from Property Tax Notice(httpY/appraisecpascogov com)
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