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sis-�ao-oo2o City of Zephyrhills Fire Fax-813-780-0021
<br /> Permit Application
<br /> Date Received ,�- � � Phone Contact for Pertnit
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<br /> Owner's Name �"S f 7 �Y G1/ �C n J ��/ /�f�!7� p�er's Phone Number � � �
<br /> Owner'sAddress y J 3 � ��� L ('.��1 S /
<br /> Fee Simple Titleholder Name Titleholder Phone Number � � ��
<br /> Fee Simple Titleholder Address
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<br /> Job Address �
<br /> Lot#
<br /> Sub Division Parcel#
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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 /> aControlled Burn � Hood Installation ,
<br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation -
<br /> � Emergency Generator>30 kw a LP/Natural Gas-ANNUAL Sale �?
<br /> Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL �j� � �
<br /> ��y emi �n er � +t
<br /> Sprinkler (� ❑ ❑ � � Recreational Bum : ;`
<br /> P 4, �
<br /> Fire Alarm � ❑ ❑ ❑ �� � S arklers � „,,,>�"�
<br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installafid�,g
<br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys)
<br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle
<br /> a Fire Pumps a 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 Current Y/N
<br /> Address License#
<br /> PLUMBER
<br /> Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> MECHANfCAL Company
<br /> 5ignature Registered Y/N Fee Current Y/N
<br /> Address License#
<br />�THER
<br /> Company
<br /> 3ignature _ ------__ _ Registered Y/N Fee Current Y/N
<br /> Address License#
<br />�irections:
<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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