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° s;�•-�so-oc2o Ciiy of Zephyrhills Fire Fax-a;saso-oc2i
<br /> Permit Application
<br /> Dat=R=ceived _I'� � f _ Phone Contact for Permit � �� �
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<br /> Owner's Name '� 1� � � �
<br /> W L�.�1 �1NQS �/�1/n G L L L Owner's Phone Number
<br /> Owner's Address (I �'v R LE�✓ A Lrn `t-��l g-3 ' 11J���
<br /> ree Simpie Titieholder Name Titlehoider Phone Number � � �
<br /> r==Simole i itl=hold=r Address
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<br /> JobAddress �j�Z{ ) � T L�/p z � ry� " .,; � Lot`� r�
<br /> Sub Division Parcel€ �� .� _� OD
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<br /> � Bio-Hazard Waste Storage-ANNUAL � Fumioation Tent "—'-
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<br /> � Comm Exhaust Kiichen HoodlDuct , � Hazardous Material(Tier II or racility)ANNUAL
<br /> � Controlled Bum � Hood Installation
<br /> � cmergency Generator<30 kw � LPlNatural Gas-Installafi n /[f�� �j
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<br /> � Emergency G=nerator>30 kw � LP/Natural Gas-ANNUAL Sale
<br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNU
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<br /> Sprinkler � ❑ ❑ p � � RecreaUonal Bum ""
<br /> Fire Alarm � O ❑ ❑ � � Sparklers
<br /> Hood Cleaning � � ❑ ❑ � � Sprinkler System Installations
<br /> Hood Suppression � ❑ �� ❑ � � Standpipes(Sprinkier Sys)
<br /> � Fire Alarm Instaifation � Torch RoofinglTar Kettle
<br /> � Fire Pumps � Waste Tire Storege ANNUAL
<br /> � Fire Works
<br /> � Ftammable Application-ANNUAL Valuation or"Project
<br /> � Fuei Tanks
<br /> � Other�
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<br /> Contractor Company
<br /> Signature Registered Y/N Fe=Current Y/N
<br /> Address License#
<br /> cLECTRICIAN Company
<br /> 5ignaiure Registered Y/N Fee Current Y/N
<br /> Address License�
<br /> P�UN�B�R Company
<br /> Sigrature Registered Y/N Fe=Current Y/N
<br /> Address License�
<br /> McCHANICAL Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Addr=ss License�
<br /> OTH�R �� � Company - _ i2q'-= "�N .
<br /> Signature - Registered /N ree Current Y/N
<br /> Address License�
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<br /> Directions: _ _ ,-,. ._. .., _ ..�..... . ..... ..r.�.:r :.
<br /> Fill out application completely
<br /> Owner&Contractor sign back of apolication,notarized(Or,copy of signed contract with owner)
<br /> I�over 52500,a Notice of Commencement is required(Mechanical work over W5000)
<br /> Supply two(2)sets of drawing�with applicabl=documentaiion
<br /> Aliow 1 C-14 days for revi=w after submittai dat� Parcel�-ob,ained from Property Tax.Noti�e(http://appraiser.pasoogov.com)
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