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` 813-780-0020 City of Zephyrhills Fire Fax-813-780-0021
<br /> Permit Application
<br /> Date Received Z— � Phone Contact for Permit s �
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<br /> Owner's Name �i�� Gc I N '� Owner's Phone Number l( �� ��
<br /> Owner's Address ,J Z ( '�v^` �U�f1 hl� (� T` G t�, L�'�G� �v �
<br /> �•�.,, � Titleholder PF�pae-NCimber �I ��
<br /> Fee Simple Titleholder Name _ -
<br /> Fee Simple Titleholder Address .-'
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<br /> Job Address 'j% �V � ` �Ti �C'' V i � J C � Lot#
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<br /> Sub Drvision _ �_� , .-. . ;.-, <�. x�� �
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<br /> � eBio-Hazard Waste Storage-ANNUAL � Fumigation Tent
<br /> � Comm Exhaust Kitchen Hood/Duct Hazardous Material(Tier II or RQ Facility)ANNUAL
<br /> a Controlled Bum � Hood Installation ��� �c,' � ���
<br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation ` i/ �
<br /> aLP/Natural Gas-ANNUAL Sale V -�r—
<br /> Emergency Generator>30 kw � ��� ��[.L/
<br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL
<br /> t y emi �n er �•�
<br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum
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<br /> Fire Alarm � ❑ ❑ O � � Sparklers ���f/
<br /> Hood Cleaning � � ❑ � � Sprinkler System Install ' ns �� � �
<br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkl SYs)
<br /> � Fire Alarm Installation � Torch Roofing/Tar K e ,
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> � Fire Works
<br /> � Flammable Application-ANNUAL Valuation of Project
<br /> � Fuel Tanks
<br /> Q Other:
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<br /> Contractor �/ Company � n fi Y-�
<br /> Signature � Registered Y/N Fee Current Y/N
<br /> Address License#
<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/N
<br /> Address License#
<br /> OTHER Company
<br /> Signature Registered Y/N Fee Current Y/N
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<br /> Address License#
<br /> Directions:
<br /> Fill out application completely
<br /> Owner 8 Contractor sign back of application,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(hrip://appraiser.pascogov.com)
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