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Fax-813-780-0021
<br /> ~ gl3aeo-oo2o City of Zephyrhills Fire
<br /> Permit Application
<br /> �, Phone Contact for Pertnit
<br /> ate Received .��..,.�,� � .. Y , =.,y,�:�-•���,. .,.__.,.,. C�
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<br /> r_..+ - _ . ..:«�:�au� ��
<br /> r t� n � Owner's Phone Number
<br /> nnmer's Name L °Y`
<br /> Mrner's Address SCS( +-^�`'� � � � �`0'�� �! 3 �� � C�
<br /> Titleholder Phone Number C-.—� .J
<br /> ee Simple Titleholder Name
<br />�ee Simple Titleholder Address �, ���`'""�"""�''"``"�*�"����� �
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<br /> .�- s.:ar��.:,.�>:�^��s-.��>� C�
<br /> � O .,D ✓ 8�� �� Lot#
<br /> <•�
<br /> lob Address
<br /> Parcel# , ,��..��,,,.,..
<br /> 5ub Division �<,_ , , ..:,4 . .. �. ., , '�. ' `,. �.,�. . �. ,
<br /> � „ .� . {��.��:.� ._. .a�,.�����a.���g_�. .��,.a o. .,. .: n
<br /> � Fumigation Tent
<br /> Bio-Hazard Waste Storage-ANNUAL �
<br /> � Comm Exhaust Kitchen Hood/Duct Hazardous Material(Tier II or RQ Facility)ANNUAL
<br /> aHood Installation �'`
<br /> aControlled Bum a ' � �l `� �
<br /> � LP/Natural Gas-Installati (� G
<br /> Emergency Generator<30 kw � LPlNatural Gas-ANNU L Sale �
<br /> � Emergency Generator>30 kw � j�
<br /> a Places of Assembly- UAL /
<br /> Fire Protection Maintenance-ANNUAL �/
<br /> ❑� emi � er ❑
<br /> � � � Recreational Bum
<br /> Sprinkler � ❑
<br /> ❑ � � p Sparklers
<br /> Fire Alartn ❑
<br /> Sprinkler System Installations
<br /> Hood Cleaning � � � � � ❑
<br /> Hood Suppression � ❑ ❑ � Standpipes(Sprinkler Sys)
<br /> � Fire Alarm Installation � Torch RoofinglTar Kettle
<br /> � � Waste Tire Storage ANNUAL
<br /> Fire Pumps
<br /> � Fire Works
<br /> ❑ Valuation of Project
<br /> Flammable Application-ANNUAL
<br /> � Fuel Tanks
<br /> � Other: �_��:�.��_ . , �, .� .
<br /> R��..: . �� . �.�.. �>.,..�.�:
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<br /> Company eS r� � reS'ac'�- �''°
<br /> Contractor n Registered Y/ F Current Y/N
<br /> Signature r �
<br /> License#
<br /> Address
<br /> Company
<br /> ELECTRICIAN
<br /> Registered Y 1 N Fee Current Y/
<br /> Signature
<br /> � License#
<br /> Address
<br /> Company
<br /> PLUMBER Registered Y/N Fee Current Y/N
<br /> Sig�ature
<br /> License#
<br /> Address
<br /> Company
<br /> MECHANICAL
<br /> Registered Y/N Fee Curtent Y�
<br /> Signature
<br /> License#
<br /> Address
<br /> OTHER Company
<br /> Registered Y/N Fee Current Y/N
<br /> Signature
<br /> License# ,�—
<br /> Address
<br /> e
<br /> Directio�s:
<br /> Fill out application comp�etely
<br /> Owner&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 documentaiion
<br /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com)
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