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a;?�so-oczo City of Zephyrhills Fire raX-a13-780-0021
<br /> Permit Appiication _
<br /> . .
<br /> Date Received I � _ _ Phone Contact for Permit �,_�
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<br /> Owner's Name � " A � T � .IJ._ f G Owner's Phone Number � � ��
<br /> Owner's Address � U �ELLS T � S 7 rrl / � �SN�t1C/�pbL1_5 �/(f v;j � - 9d 3
<br /> Fee 5imole Titleholder Name Titleholder Phone Number � ��
<br /> ree Simole l'itieholder Address
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<br /> Job Address , , ,I��j� I �jU Pf�'L ((TY �0%.)�M1 �� Lot4� �
<br /> Sub Division Parcel� ��`�� � / 'Q�(�CJ "
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<br /> � Bio-Ha�ard Waste Storege-ANNUAL � Fumiaation Tent
<br /> � Comm Exhaust Ki'tchen HoodlDuct , � Hazardous Material(Tier II or RC2 Facility)ANNUAL
<br /> � Controlled Bum � Hood Instailation
<br /> � Emergency Generetor<30 kw � LP/Natural Gas-Installation
<br /> � Emergency Generator>30 kw a LP/Natural Gas-ANNUAL Sate
<br /> -� Fire Protection Maintenance-ANNUAL � Places of Assembiy-ANNUAL
<br /> tny emi ni ner
<br /> Sprinkier � ❑ ❑ ❑ B � Recreafional Bum l�� �
<br /> �
<br /> Fire Alarm � G ❑ ❑ � � Sparklers
<br /> Hood Geaning � G G C � � Sprinkler System Ins.allations
<br /> Hood Suppression "� ❑ �y ❑ � � Standpipes(Sprinkler Sys)
<br /> � Fire Alarm Installation � Torch RoofinglTar Kettle
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> � Fir=Works
<br /> � rtammable Application-ANNUAL Valuation of Project
<br /> � Fuel Tanks
<br /> � Other
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<br /> Contractor Company
<br /> Signature Registered Y 1 N Fee Current Y/N
<br /> Address License#
<br /> ELECTRICIAN Company
<br /> 5igraiure Registered Y/N Fee Current Y/N
<br /> Address License# � —�
<br /> PLUM3ER Company �—
<br /> Signature Registered Y/N Fe�e Current Y/N
<br /> Address License# �—
<br /> MECHANICAL Company
<br /> Signature Registered Y/N FE:=Current Y/N
<br /> Addr=ss License� � —�
<br /> OTHEP, • Company 1/�L/l. �-1/��` �C7,�GL/�1,t1
<br /> Signature Registered /N Fee Current Y/N
<br /> Address , �l . Cx License�
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<br /> Directions: 3 ..
<br /> Fill out application completely
<br /> Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner)
<br /> 1�over�2500,a Notice o`Commencemen,is required(Mechanica!work over W5000)
<br /> Supply two(2)sets of drewings with applicabl=documentafion
<br /> Allo��1 G-1�days for r=view after submittal date. Parcei r-ob,ained rrom Froperty Tax Noti�e(nttp./lappraise-.p2scogov.com)
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