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a�saso-oa2o City of Zephyrhills Fir•e Fax-s�3aaaoozi
<br /> Permit Application
<br /> Date Received
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<br /> Phone Contact for Pe
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<br /> Owner's Name e � �, Owner's Phone Number g�3 � � Z,3 y P Z'z�
<br /> Owner's Address � ��a�y1 �
<br /> Fee Simple Titleholder Name Titleholder Phone Number � � C�
<br /> Fee Simple Titleholder Address
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<br /> JobAddress Q�) ,V ��
<br /> Lot#
<br /> Sub Division � Paroel# �Q–'j�(p – Z,��QQ � p
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<br /> � Bio-Hazard Wa e Storage-ANNUAL � Fumigation Tent
<br /> � Comm Exhaust ,itchen HoodlDuct � Hazardous Material(Tier ii or RQ Facility)ANNUAL
<br /> � Controlled Bum ' � Hood Installation
<br /> � Emergency Ge rator�30 kw � LPJNatural Gas-Installation
<br /> � Emergency Ge rator>30 kw � LP/Natural Gas-ANNUAL Sale
<br /> � Fire Protection aintenance-ANNUAL � Piaces of Assembly-ANNUAL
<br /> ❑ r y emi � er �
<br /> Sprinkler ❑ p ❑ Recreational Bum
<br /> Fire Alarm � p ❑ ❑ Sparklers
<br /> Hood Cleaning � ❑ ❑ ❑ C] � Sprinkler System installations
<br /> Hood Suppress n � ❑ ❑ O �� � Standpipes(Sprinkler Sys)
<br /> � Fire Alarm Insta l�tion � Torch Ro�ngRar Kettle
<br /> Fire Pumps Q Waste Tire Storege ANNUAL
<br /> Fire Works
<br /> Flammable App ication-ANNUAL �—�� Valuation of Project
<br /> Fuel Tanks
<br /> QOther:
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<br /> Contractor
<br /> Company —�
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> ELECTRICIAN Company —�
<br /> Signature
<br /> Registered Y/N Fee Current Y/N
<br /> Address
<br /> License#
<br /> PLUMBER Company �—
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address
<br /> License#
<br /> MECHANICAL Company
<br /> Signature Registered Y/N Fee Gurrent Y/N
<br /> Address
<br /> License#
<br /> OTHER Company —"�
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License# --�
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<br /> Directions: �> ,� �xrr ,..�.,_._.....,,a ,��.,.M�.�..�..�,....��,.,�,...�._.�,u.,,,�.�.»FUa �.. :�.,::
<br /> Fill out appiication com letely
<br /> Owner 8 Contrector sig 6ack of application,notarized(Or,copy of signed contrect with owner)
<br /> If over$2500,a Notice f Commencement is required{Mechanical work over$5000)
<br /> Supply two(2)sets of d wings with applicable documentation
<br /> Allow 16-�4 days for re iew after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com)
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