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s�saao-oo2o City of Zephyrhills Fire
<br /> Fax-813-�80-002'
<br /> Permit Application
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<br /> Date Received — — �
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<br /> Phone Contact for Permit
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<br /> �wner's Name �/� �/�$ � OLVT/Afl1 OwnePS Phone Number Q/�, p ?j7J 9��
<br /> Owner s Address f!d. �'�' OX l /6 C,(fTZ �iG 3%��a �
<br /> FeP S�mple Titleholder Name Titleholder Phone Number � � �
<br /> F��`��^�Gie Tdlehoitler Address J
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<br /> Bio-Hazard Waste Storage-ANNUAL � Hazardous Material(Tier il or RQ Faciliry)ANNUAL
<br /> � Comm Exhaust Kitchen Hood/Duct �
<br /> r--� Hood InstailaUOn
<br /> (� Controited Bum � LPlNatural Gas-Instaliation
<br /> � Emer�ency Generator<30 kw � LplNatural Gas-ANNUAL Sale
<br /> � Emer,yency Generator>30 icw
<br /> � Pleces of Assembly-ANNUAL
<br /> � F+re Profection Mafntenance-ANNUAL Q `
<br /> Recreational Burn �
<br /> �� emi �nT, er ❑ (
<br /> Sprinkler � � � �
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<br /> Sparklers
<br /> Fire Alarm � � � M � ❑
<br /> ❑ �°' Sprinkler System Instailations
<br /> Hood Cleaning � � �
<br /> � � Standpipes(Sprinkler Sys)
<br /> Hooa Suppression p � � �
<br /> � � 7orch Roofing/far Kettle
<br /> Fire Alarm InstaUadon a
<br /> ❑ Waste Tire Storage ANNUAL
<br /> Fire Pumps
<br /> � Fire Works
<br /> � �iammable ApplicaGon-ANNUAL
<br /> � Fuel Tanks Valuation of Project
<br /> ❑ Other
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<br /> Signature Company —`^ ,�,�` ���,Q '
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<br /> R istered Y/N Fee Current Y/N
<br /> Address 35 31 KE !�}�yn� Rd.
<br /> License# E F 0000 H�l t ��'�
<br /> FLCCTRICIAN
<br /> S�gnature Company
<br /> Adtlress Re9�Stered Y/N Fee Current Y/N
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<br /> PL'JMoER .`_. —.�
<br /> S�cna[ure Company
<br /> Address
<br /> Registered Y/N Fee Current Y/N
<br /> MErHANICAL License# ��
<br /> S,gnature Company "�—
<br /> AdnrESs
<br /> Registered Y/1V Fee Current Y/N
<br /> (�THEP
<br /> License# �
<br /> S�gnature Company
<br /> Address
<br /> Registered Y/IV Fee Current �Y/N
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<br /> ���ect,ons -- �=° -=�=- License# '--
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<br /> �tll out aPPl��tion completeiy '-�- -'- - ' �- -- -
<br /> Owner S Contractor sign back of appllcaUpn,notarized(Or,copy of signed conUact with owner)
<br /> If over 52500,a Notice of Commencement is requved(Meehanical work over$5000)
<br /> Suppiy�vo(p�sees of drawmgs with applicable documentation
<br /> Auow 10-14 days f�r review after submittal date.
<br /> Parcel#-obtained from Property Tax Notice(http:/lappraiser.pasCOgov comj
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