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. a��aao-oo2o City of Zephyrhills Fire Fax-813-780-0021
<br /> Permit Application
<br /> Date Received I Phone Contact for Permit �Jv� -1 ' �j S�t L ('=�,-r�„S'�„
<br /> Owner's Name �f-1� 1 �S(- V C T�1��T�rIG/t�75 LT� Owner's Phone Number � C� �
<br /> Owner's Address ��C) � Z L �j,E- L,V(J �7� J�� ��j�f� Y LKt�F1 � ��yD�j - � �J(o(�
<br /> Fee Simple Titleholder Name Titleholder Phone Number � C�
<br /> Fee Simple 7iileholder Address
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<br /> `�' �'.^Fyi ',axate#5:x�'>ai7;7:yso }?$%:°' :!C 3d.':i{��„'' '�'f"�?�r..�,+..;
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<br /> Job Address � `Y �� ti(A L � � �Z�C �,, C Lot� ��
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<br /> Sub Division Parcel� �`� -�`j -�► -bp� (�j -�c� d - ��,� ,
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<br /> � Bio-HazardWastsStorege-ANNUAL � FumigationTent
<br /> � Comm Exhaust Kitchen HoodlDuct � Hazardous Material(Tier tl or RQ Facility}ANNUAL
<br /> � Controlled Bum � Hood Installation
<br /> Emergency Generator<30 kw � LPlNatural Gas-Instaliation (�
<br /> � Emergency Generetor>30 kw � LP/Natural Gas-ANNUAL Safe � ����
<br /> �-- Fire Protection Maintenance-ANNUAL a Places of Assembly-ANNUAL
<br /> r y emi � er
<br /> Sprinkler � Q ❑ �4- � � Recreational Bum
<br /> Fire Alarm � ❑ ❑ -�` � � Sparklers
<br /> Hood Cleaning � ,_; ,� ❑ � � Sprinkler System tnstaflations
<br /> Hood Suppression � � _, ❑ � � Standpipes(Sprinkier Sys)
<br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> r( Flammabie Application-ANNUAL �— � Valuation of Project
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<br /> Fuei Tanks
<br /> � Other:
<br /> _°°:� �°.;�
<br /> . „ ., ` . .. ... .__..tt. ..< . " .� ....':�'.. . ..... .,o�.. ..::5ki. �_�:y;'. .a.>r., �. .. ... :>'�:.,�,.;..s.: .p-��v:. ��F;- "s^:'l>;..:',� z�:zz°::.'�S'e*:�_r.x�'<`y:�.�,.,3.;:�£�M:�`a.
<br /> Contractor
<br /> Company
<br /> Signature Registered Y/N Fe=Current Y/N
<br /> Address
<br /> License#
<br /> ELECTRICIAN Company
<br /> Sigrature Registered Y/N Fee Current Y/(V
<br /> Address
<br /> License�
<br /> PLUMBER Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address
<br /> License#
<br /> MECHANICAL
<br /> Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address
<br /> License#
<br /> OTHER � Com an � ` 5��,� �ti,�
<br /> Signature �l��,(_ � -� �-c�—' Registered � /N ` Fee Current Y/N
<br /> Address <"d I C'G rr vr t- .e' i =-L -3,�'7 7('i License# --,(=("j p p } � �
<br /> Directions: 4 - �-.` "„ . ; "
<br /> Fill out appiication completely 1 j � �� y(`j� �j � , � �1�� `
<br /> Owner&Contractor sign back of application,�otarized(Or,copy of signed contract with owner)
<br /> If over�2500,a Notice o`Commencement is required(Mecharncal work over$5000)
<br /> Supply two(2)sets of drawings with applicable documentation
<br /> Ailow 1 C-14 days for r=view after submittai date. Parcel#-obtained from Property Tax Notice(http./iappraiser.pascogov.com)
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