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813-780-0020
<br /> City of Zephyrhills Fire Fax-813-780-0021
<br /> Permit Application
<br /> � a Phone Contact for Pertnit �% / � �'y�'
<br /> ate Received • 1 �7�( ,�,.,>a, .,��.�, .. ..�--��..-<T� ; .,_� _. _...�r������..�..�.� �or��,,._..
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<br />`�H�, Y P:". , /- Ovmer's Phone Number '� fl( ��o Gv��/
<br /> wner's Name �`, O��•'�' Li.l� !7�7`L �C �
<br />�wner's Address �G� C� � � �-� � Z� �� `( �(
<br /> Titieholder Phone Number �� �� ��
<br /> ee Simple Titleholder Name
<br /> ee Simple Titleholder Address �- �rv-�,�_•���;;«�� .��
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<br /> �:m,.:c�'�:�,:�w:,:la�:�&ca' w+.'
<br /> {� Lot#
<br /> iob Address Ju�v`'��
<br /> Paroel#
<br /> iub Division „ _, �.�-�;�,�� �r=�-.��,r, �- ,. . .. � �.���s��*�.�a.-.
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<br /> � Bio-Hazard Waste Storage-ANNUAL a Fumigation Tent
<br /> � Comm Exhaust Kitchen Hood/Duct a Hazardous Material(Tier II or RQ Facility)ANNUAL
<br /> � Controlled Burn � Hood Installation
<br /> � Emergency Generator<30 kw a LP/Natural Gas-Installation
<br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale �
<br /> � Fire Protection Maintenance-ANNUAL a Places of Assembly-ANNUAL /L/
<br /> � emi [�n er � l�� v
<br /> ❑ � � Recreational Bum � �
<br /> Sprinkler � � �
<br /> Fire Alarm � ❑ ❑ ❑ � a Sparklers
<br /> Hood Cleaning � � � � Sprinkler System Installations
<br /> Hood Suppression � ❑ � � �� � Standpipes(Sprinkler Sys)
<br /> � Fire Alarm Installation � Toroh Roofing/Tar Kettle
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> � Fire Works ^
<br /> � Flammable Application-ANNUAL � Valuation of Project
<br /> � Fuel Tanks
<br /> Q Other:
<br /> ,V�.�;�,��, ,.�_ �. :���, �
<br />, �;�.�.. .�,..:��,.� „�.��.-�;���� ��,,..
<br /> Contractor - Company F�7`G .�I� h'�� l'? `-
<br /> r��.�,,, � — .._____
<br /> Signature �,_. Registered Y/N Fee Current Y/N
<br /> Address .0� Bv{� �fJ� �r d L�1 7 ..3�f�� 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 Cutrent Y/N
<br /> Address License#
<br /> �
<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:/lappraiser.pascogov.com)
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