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a�aaao-oo2o CityofZephyrhillsFire �j 2��3 Fax-813-780-0021
<br /> ' Permit Application � J
<br /> Date Received � .� Phone Contact for Permit
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<br /> Owner's Name s � Owner's Phone Number �y� � ��
<br /> Owner's Address c�`7 �• /� � �
<br /> Fee Simple Titleholder Name l�l� � eS{� �U� Titleholder Phone Number �� C� �
<br /> Fee Simple Titleholder Address f S
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<br /> Job Address Lot#
<br /> Sub Division Paroel# ' �—�� ��—��'�"� �}S7� �o
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<br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent
<br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL
<br /> � Controlled Bum � Hood Installation
<br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation
<br /> Emergency Generator>30 kw LP/Natural Gas-ANNUAL Sale � ?�
<br /> � Fire Protection Maintenance-ANNUAL Places of Assembly-ANNUAL i ���!,1 ,/y � �
<br /> �y emi �n er ��� ,� I�i�"(,1 G�
<br /> Sprinkler � ❑ ❑ ❑ � Recreational Bum ��C�,j IM/\ n //,
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<br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers A(����;��Y'�'�(
<br /> ���1'T►t�.
<br /> Hood Cleaning � ❑ ❑ ❑ � � Spri�kler System Installations
<br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) Z"��,
<br /> � Fire Alarm Installation � Torch RoofingfTar Kettle �
<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
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> ELECTRICIAN Company
<br /> Signature Registered Y/N Fee CuRent 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
<br /> s
<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(http://appraiser.pascogov.com)
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