|
813-780-0020 City of Zephyrhills Fire Fax-813-780-0021
<br /> . � Permit Application
<br /> Date Received Phone Contact for Permit `7�/3 �p a C(�(JD
<br /> -...�. . t .<�« a . { � ...e..,. ua......s v.w.. .__..a., anT�ua_"s9ad:�`�al'�.��.e w.. x. ..... �.::T ...:�L�....,._._..__,... e. —'• . v-��d'''&w�;�,'�:���:�>G.......a�etw+.c.d..s-..✓w...........n_L.......,sm.iew> ....
<br /> Owner's Name �'L�, f D$• � I�G 1 ze � ( j � Owner's Phone Number � � �
<br /> Owner's Address Q � Ci �� �1�(� � h� �1 $ �. y �
<br /> Fee Simple Titleholder Name Titleholder Phone Number � � �
<br /> Fee Simple Titleholder Address
<br /> ::a'a','.z�;�.�z:H..., -,.>;:. . .a�y��:=;;,'° .:?L`_��ais�°. ::i"?":�"3�a�,u��"'�•�.M?���'M,ctz�.:- `-s:.2.>.�n.._;:�„:e`:¢"�'.�'�s`r�_:�';r:°.-�,.�;., •.".g.X'�;.°";':%r
<br /> ��< .-sr.E..°'a�'.3�zz� �:.a.� �',��:mX�:i. .:��`:" s�,'"�;'�" �`I
<br /> Job Address ��s�� (�'� I� �+ff� Z� � �' Y�� �IS l�L- ,3,3,51( � Lot# N.�
<br /> Sub Division Parcel#
<br /> �... m. ._...„. _ .. . �. _...>_. _...,. _,.<.q_.. _ , �.., - > � .
<br /> -,„ �_. ,.�,�,�,� ,
<br /> � .� -
<br /> . .,._.:, , ... , • r• . . .._ _ . ,�..,. .. .. �,.� .. _. .,� �,. .. � � a . ,- < .. .
<br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent
<br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL
<br /> � Controlled Burn � Hood Installation
<br /> � Emergency Generator<30 kw � lP/Natural Gas-Instailation i�7 s'
<br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale `��%�(
<br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL �
<br /> t y emi �n t er
<br /> Sprinkler � ❑ ❑ ❑ � � Recreational Burn
<br /> Fire Alarm � ❑ � ❑ � � Sparklers !�
<br /> ,�r r�t'��/
<br /> Hood Cleaning � ❑ ❑ ❑ � O SpnnklerSystem Installations ` �I'`
<br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) Lr��/�'��
<br /> � Fire Alarm Instailation � Torch Roofing/Tar Kettle �
<br /> � Fire Pumps � Waste Tire Storage ANNUAL � � � �
<br /> ��e (,, is-°( �,`
<br /> � Fire Works q�p. di� 6
<br /> � Flammable Application-ANNUAL s / 'i
<br /> �,OG �,aluation of Project
<br /> � Fuel Tanks �
<br /> � Other�
<br /> __. : . ,>...,. .,... .. , ` _ . . .._ :.� ..__. ..a;:<;��s.;',:u�.. ,. �F�M � _._ __.. ... _ .. a_ .,. ,. �.._...� �..:�:.°�:.m.,. ,. '�,<<•s _s;.�'� .s�,� .,..:�A�
<br /> Contrector Company � � j��P f f', ,z— �
<br /> Signature Registered /N Fee Current /N
<br /> Address 7 U / License# �5 Od0 j/�
<br /> ELECTRICIAN Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> PLUMBER Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> MECHANICAL Company
<br /> Signature Registered Y/N Fee Current Y/I�l
<br /> Address License#
<br /> OTHER Company �—
<br /> Signature Registered Y/N F�e Current Y/N
<br /> Address License#
<br /> ,., ,_. _,
<br /> .. .......<_. .... .:�&.�3i .s:.. " Y•,.sE!c:c.i�.� esi6rssu�f.�........::c'.r2£' a.#"' .m.a � ,. . �:a� s.. •
<br /> ......C,_..._a<._.:£.... ...t_.. ._.._ _..._ _ .__.E.,,�... ,.. ..., s..�. �.ee. ......_, ..>..o... ...�.r..m .
<br /> Directions: ;i- �,. . ,
<br /> Fill out application completely
<br /> Owner&Contractor sign back of app�ication,notarized(Or,copy of signed contract with owner)
<br /> If over$2500,a Notice of Commencement is required(Mechanical work over$5000)
<br /> Supply two(2)sets of drawings with applicable documentation
<br /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com)
<br />
|