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sisaso-oo2o City of Zephyrhills Fire Fax-613-780-002�
<br /> ' Permit Application
<br /> Date Received �"�J �Z— Phone Contact for Permit �,'��l 9�12 ►9 Q 3
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<br /> Owner�s Name (3�T/{(�tl�tilQ P�eTy I'�l��,r �LG Owner's Phone Number � 7� ��� ��'/� J
<br /> Owner's Address �7/1� I U���il.(J �l �(�X��p�1Q 1�rJ ����� �
<br /> Fee Simple Titleholder Name Tit�eholder Phone Number C� � �
<br /> Fee Simple Trtleholtler Address
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<br /> JobAddress ����/.' /7� ��3� �'iFDiIAL V I�'�9�lb Z/�/�5 �-� ������ Lot# �
<br /> Sub Division Parcei#
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<br /> � Bio-Hazard Waste Storage-ANNUAL � Hazardous Material(Tier il or RQ Facility)ANNUAL
<br /> � Comm Exhaust Kitchen Hood/Duct a Nood�nstailation
<br /> � Controlled Bum � LP/Natural Gas-installation
<br /> � Emergenq Generator<30 kw a LP/Naturai Gas-ANNUAL Sale
<br /> � Emergency Generator>30 kw C Pl�ces of Assembly-ANNUAL
<br /> aFire Protection Maintenance-ANNUAL � Recreational Burn
<br /> ry emi � t er �� i �
<br /> Spnnkter � ❑ ❑ ❑ � � Sparklers ��
<br /> Fire Alarm � ❑ � �( � � Sprinkier System Installations � �
<br /> Hood Ciea�ing � ❑ ❑ ❑ � � Standpipes(Sprinkier Sys)
<br /> Hood Suppression � ❑ ❑ O � � Torch RoofinglT'ar KetUe
<br /> � Fire Alarm Instaltation a Waste Tire Storege ANNUAL
<br /> � i Fire Pumps
<br /> UFire Works
<br /> � Flammable Applicatiorn ANNUAL Valuation of Project
<br /> � Fuel Tanks
<br /> � Other:
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<br /> Contractor Company To�c.l Sp�u�'t'On . {r�c.
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address 3 5 31 K¢ ,�onQ. Ra�. license# E.F 0000 Ny� �
<br /> ELECTRICIAN Company �
<br /> S�gnature RegiStered Y/N Fee Current Y/N
<br /> Address License# � --,
<br /> PLUMBER Company
<br /> S�gnature t Registered Y/N Fee Current Y/N
<br /> Adaress License# �— —�
<br /> MECHANICAL COmpany �� �
<br /> Signature Registered Y/N Fee Currant 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 /> Duections
<br /> Fili out application completely
<br /> Owner&ConVactor sign back of apptication,notarized(Or,copy of signed contract with owner)
<br /> if over 52500,a Notice of Commencement is reqwred(Mechan�cal work over 55000)
<br /> Supply iwo(2)sets of tlrawings with applicable documentation
<br /> Allow 10-1a days for review after submittal date. Parcel ri-obtained from Properly Tax Notice(http://appraiser.p.ascogov.com)
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