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sis-�ao-oozo City of Zephyrhills Fire Fax-613-760-0021
<br /> Permit Application
<br /> , � �Z Phone Contact for Permit
<br /> Date Received /it.
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<br /> Owner'sName /�''�lSt7 (��1J b 4 � 1K�'J"' �,j,.C, p„�ner'sPhoneNumber l�S�,3 p7.2 q��
<br /> owners Address S2—�j .5 . /Vl./E'� (LL /��+/E �'�}-/1.(��„t�.. J---(, 3,�6 0 9
<br /> Fee Simple Titleholder Name �8�� ��iG�/� Titleholder Phone Number � 3 g 72. 9 ��
<br /> Fee Simple Titleholder Address �-�j
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<br /> Job Address � � ���C'" � Po,�,� z�-Pm►�.H��� Lot# �
<br /> ����� �� � ( I " T �� � Parcel#
<br /> � Hazard Waste Storage-ANNUAL � Hazardous Material(Tier II or RQ Facility)A NUA
<br /> Comm Exhaust Kitchen Hood/Duct � Hood Installation ����
<br /> r� f
<br /> � Controlled Bum � LP/Natural Gas-Iristallation �
<br /> � Emergency Generator<30 kw a LP1Natural Gas-ANNUAL Sale
<br /> � Emergency Generator>30 kw � Places of Assembly-ANNUAL
<br /> � Fire Protection Maintenance-ANNUAL � Recreational Burn
<br /> �y emi �n er ❑ �,.r`
<br /> Spnnkler � O ❑ ❑ Sparklers � � U
<br /> ` �:
<br /> Fire Aiarm � O ❑ ❑ �� � Spnnkler System Installaf ns �( �,. r
<br /> / �r
<br /> ��H_o_Q,�,�I.gani�� ❑ ❑ � � Standpipes(Sprinkler Sys)
<br /> �„��_�._,,,_,,,_..--
<br /> Hood Suppression ❑ ❑ ❑ Torch Roofing,�Tar Kettle
<br /> � Fire Alarm Instaltation � Waste Tire Stora3e ANNUAL
<br /> � Fire Pumps
<br /> Fire Works
<br /> aFlammable Application-ANNUAI r-�_-, Valuation of Project
<br /> Fuel Tanks
<br /> Q Other
<br /> Contractor � Company .e,G.,^
<br /> Signature Registered Y N Fee Current N
<br /> Address S. G � t-L 336 cJ License#
<br /> ELECTRICIAN Company
<br /> Signature Registered �Y/N Fee Current Y/N
<br /> Address r
<br /> License#
<br /> PLUMBER Company
<br /> Signature � Registered � Y/N Fee Current Y/N
<br /> Address
<br /> license#
<br /> MECHANICAL Company C
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address
<br /> License#
<br /> OTHER Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address
<br /> License#
<br /> Directions
<br /> Fill out application completely
<br /> Owner&Contractor sign back of application,notanzed(Or,copy of signed contract with owner)
<br /> If over$2500,a Notice of Commencement is required(Mechanical work over$5000)
<br /> Supply rivo(2)sets of drawings with applicable documentation
<br /> Allow 10-14 days for review after submittal date Parcel#-obta�ned from Property Tax Notice(http//appraiser.pascogov com)
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