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aisaeo-oo2o City of Zephyrhills Fire FaX-813-780-0021
<br /> - Permit Application
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<br /> Owner's Name ,�/�/�9'772c< �T�✓�!S � Owner's Phone Number �� � �
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<br /> Fee S�mDle Tdleholder Name � Titleholder Phone Number C] � �]
<br /> r_„,,pi�Titlehoider AddreSS
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<br /> JoC3Addre55 (07/� r�i,ey �j(/ 4"G/!T(�GJ��u'S [" v ��`� LOt# �
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<br /> � Bio-Hazard Waste Storage-ANNUAL � Hazardous Materiai�er II or RQ Facility)ANNUAL
<br /> � Comm Exhaust Kitcher�Hood/Duct � Nood Installation
<br /> � Conirolled Bum � LP/Naturai Gas-Instaliation
<br /> � Emergency Generator<30 kw � LP/Natural Gas-ANNUAL Sale
<br /> nEmergency Generator>30 kw � Places of AssembiyANNUAL
<br /> � Fire Protection Maintenance•ANNUAL � Recreational Burn
<br /> ry emi �n er ��-~'-"' �
<br /> Sprinkler � ❑ ❑ C � Sparfclers �� �
<br /> Fire Alarm � ❑� D � � Sprinkier System Instailat� ���
<br /> �food Cleaning ��-❑ ❑ 0--�' � Standpipes(Sprinkler ys) / �
<br /> Hood Suppression � ❑ ❑ ❑ � � Torch Roofing/Tar K ttle
<br /> � Fire AIBrrn Insialiation � Waste Tire Storage A NUAL
<br /> � Fire Pumps _�
<br /> Fire Works
<br /> � Flammable Application-ANNUAI Valuation of Project
<br /> � Fuel Tanks
<br /> ❑ Other: �—
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<br /> Con.�acior Company To �� �t„t�"1'O n—�
<br /> sgnature Registered Y/N Fee Current Y/N
<br /> Address 3531 l�+e ,�+an¢. Rati. �icense# E.FCl00 �14t
<br /> cLCCTRICIAN� � Company �—
<br /> S�gnature RegiStered Y/IV Fee Current Y I N
<br /> Address �! License#
<br /> NLUMBER � 1 Company �
<br /> S�gnature I Registered Y/N Fee Curcent Y/N
<br /> Address License#
<br /> MECHANICAL � COmpany
<br /> Signature Registered Y!N Fee Current Y/N
<br /> Address License�i
<br /> OTHER � Company � —�
<br /> 9gnature Registered Y/N Fee Current Y/N
<br /> Address L�Cense#
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<br /> Duecuons
<br /> F�II out apphcation completely
<br /> Owner&Contractor si9n back��f apphcation,noWrized(Or,copy of signed conVact with owner)
<br /> if over 52500,a Notice of Commencement is reqwred(MechaniCal work over 55000)
<br /> Supply two(2)sets of draw�ng5 wfth applicable documentation
<br /> Allow 10-14 days for revlew after submittal date. Parcel#-obtained from Propsrty Tax NoUCe(http:qappraiser pascogov com)
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