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8��-78o-oozo City of Zephyrhills Fire Fax-8�aaso-oozi
<br /> , Permi±Application
<br /> Dat=Received i Contact for Permit
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<br /> Owner's Name L. C�) uN�'�/u �LV TSONS L L� Owner's Phon=Number C� C� �
<br /> Owner's Address �O =L�LS �F��(Tb GClu2/L 9D 5 �] - . �i��L=A�'6Lrt5 i�lU J,S�I
<br /> r=ee Simple Titieholder Name Titleholder Phone Number � �
<br /> ree Simple"fitieholder Address
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<br /> JobAddress �JO 3�J 1"Q[1 T� �(�N(� � (� Lot� �
<br /> Sub Division Parcel,= .�7'�� -�! -C70 !D -o7►D6-DooD
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<br /> � Bio-Hazard Waste Storege-ANNUAL � Fumioation Tent
<br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ racility)ANNUAL
<br /> � Controlled Bum � Hood installation
<br /> � �mergency Generetor<30 kw � LP/Natural Gas-Installation
<br /> � Emergency Generetor>30 kw � LP/Natural Gas-ANNUAL Saie
<br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL � �
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<br /> Sprinkler � O ❑ Ci � Recrea5onal Bum � I 3 '
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<br /> Fire Alarm � O ❑ ❑ � � Sparklers
<br /> Hood Cieaning � �, ❑ ❑ � � Sprinkler 5yst2m Installations
<br /> Hood 5uppression � ❑ g�„ ❑ � � Standpipes(Sprinkler Sys)
<br /> � Fire Alarm Installation a Torch Roofing/Tar Kettle
<br /> Fire Pumps � Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> Flammable Application-ANNUAL Valuation of Project
<br /> � Fuei Tanks
<br /> Q Other
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<br /> Contractor
<br /> Company
<br /> Signature Registered Y 1 N Fee Current Y/N
<br /> Address
<br /> License#
<br /> cLECTRICIAN Company
<br /> Signature Registered Y/N Fee Current �(/N
<br /> Address
<br /> License#
<br /> PLUtviB�R Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address
<br /> License#
<br /> MECHANICAL Company
<br /> Signature Registered Y/N Fee Currsrtt' Y/N
<br /> Address License# ��
<br /> OTHER . Co ny L72 e� �ieO T[-' TTUN T C_
<br /> Signature egistered /N Fee Gurrent /N
<br /> Address �.Z/ mm�.e
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<br /> 1_,9/�G. �70 License#
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<br /> Directions: . _._ ._. .. :.._ . ,:�...�_.,.:,;, •<,:.
<br /> Fill out application completely � � � �C��5�„ `,`�� `/
<br /> Owner&Contrector sign back of application,notarized(Or,copy of signed contract wi owner) '�-�K' �,v
<br /> G over 52500,a Notice o`Commencemen,is required(Mechanical work over$SODO) � � � i-� �w"��Ju %
<br /> Suppiy[wo(2)sets of drawings with applicabls documentaiion �� (Q�� -
<br /> Ailow 1 C-14 days for r=view after subrnittai aate Parcel F-obtained from Pro y Tax Noti�e(http://appraiser.pascogov.com)
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