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a��-�so-oczc City of Zephyrhills Fire Fax-8;aaso-oc2�
<br /> ,,, Permit Application _
<br /> Date Received � Phone Contact for Permit �
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<br /> Owner'a Name ��7 v�� ,�� Q �)� ti{j / l,.�C, pwner's Phone Number �� � �
<br /> Owner's Address Q (,.J [ LL..S � ►� T� S �{ I Y � � L y vr 5 �
<br /> r=ee Sim le Titleholder Name �� � � �
<br /> P Titleholder Phone Number ��
<br /> Fee SimpleTitlehold=rAddress
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<br /> Job Address � �j�� - " /U Lot� �
<br /> Sub Division Parcei� ' � �� _ _ '�
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<br /> � Bio-Hazard Waste Storege-ANNUAL � Fumiaation Tent
<br /> � Comm Exhaust Kiichen Hood/Duct , � Hazardous Material(Tier II or RQ Facility)ANNUAL
<br /> � Controlled Bum � Hood Instalfation �f_
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<br /> �mergency Generetor<30 kw � LP/Natural Gas-Installafion ( L2 ' (
<br /> � Emergency Genera'tor>30 kw � LP/Natural Gas-ANNUAL Sale L J
<br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL �
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<br /> Sprinkier � �r' p ❑ � � Recreational Bum
<br /> Fire Alarm � ❑ O ❑ � � Sparklers
<br /> Hood Cleaning � r ❑ ❑ � � Sprinkler 5ystem Installa`Jons
<br /> Hood Suppression � ❑ u ❑ � � 5tandpipes(Sprinkler Sys)
<br /> � Fire Alartn Instailation � Torch Roofing/Tar Kettle
<br /> � rire Pumps � Waste Tire Storage ANNUAL
<br /> � Fire Works
<br /> � Flammable Applicztion-ANNUAL Vaivation of Project
<br /> � Fuel Tanks
<br /> � Other�
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<br /> Contrector Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address
<br /> License�
<br /> ELECTRICIAN Company
<br /> Sigrature Registered Y/N Eee Current Y/N
<br /> Address
<br /> License�
<br /> PLUMB�R Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address
<br /> Licensz#
<br /> MECHANICAL Company
<br /> Signature Registered Y/N 'ree Current Y/N
<br /> Addr=ss
<br /> License#
<br /> OTH�R , Company �2 � �C �T-
<br /> Signature Registered �/N � ree Current N
<br /> Address , ( �,y-� --
<br /> _ ;,,, License� y S ►. a 3 t7 va I ! � 9
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<br /> Directions: _... ._.. _m :,.:,.:.,_..a.._,,... - w.._.,_.._.,�.,__._,.. _..<.�„ - _.__. ._.
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<br /> Fill out application completely
<br /> Owner&Contractor sigr back of aoplication,notarized(Or copy of signed contrect with owner)
<br /> li over S250G z Notice o`Commencemen,is required(tvlechanical work over W5000)
<br /> Supply two(2)sets of drawings with applicabl=documentation
<br /> Aliow 1 G-14 cays for rewew after submittai date Parcei�-obtained irom Property Tar.Notice(http./iappraiser.pascogov.com)
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