|
813-780-0020 City of Zephyrhills Fire Fax-813-780-0021
<br /> �� Permit Application
<br /> Date Received t�i —Z"��( Phone Contact for Permit '�� �q� (,��
<br /> ew_.�....�..:,.,x..>.5 , _ . , . .r,.�����.;a,., ,,�..is�m.tr,r-., s.�m...�,.a.m-.-�rs �.� .m-'v,r,sani. -
<br /> Owner's Name � /"�L`J J� (�'�Py1 �/�/'V�1�� Owner's Phone Number �( 3 � 2.Z7$r
<br /> Ovmer's Address �O D-3�O �/�'P�LHI V�i�(/� Z�./ll,rj 3 3 S `F Z-
<br /> Fee Simple Titleholder Name Titleholder Phone Number � � �
<br /> Fee Simple Titleholder Address
<br /> :�-_t<.v �:r����,�:��s�s..�a�.��as ��_.. °��z�w. �.��t���a��r a�.��;a�� � � , , -°�.z���•,:
<br /> Job Address ` �,2 Lot# �
<br /> Sub Division Parcel#
<br /> F ., ..:.�_ >m .. , �.,.�...-e� _„ ,__.,- .,,-�. � ,� . ,�,�..<� . ,,__ �. �-•: �. , ,.,.k. , > , , :�..
<br /> aBio-Hazard Waste Storage-ANNUAL � Fumigation Tent
<br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL
<br /> � Controlled Burn � Hood Instailation
<br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation
<br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale
<br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL
<br /> �y emi �n er
<br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum (fi��
<br /> ❑ 0 � � � � �
<br /> Fire Alarm ❑ ❑ O Sparklers �
<br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations
<br /> Hood Suppression � ❑ � ❑ � � Standpipes(Sprinkler Sys)
<br /> � Fire Alartn Installation � Toroh Roofing/Tar Kettle
<br /> a Fire Pumps � Waste Tire Storage ANNUAL ( �/ ��
<br /> � Fire Works (�
<br /> � Flammable Application-ANNUAL Valuation of Project
<br /> � Fuel Tanks
<br /> Q Othef:
<br />� �_..,� . .. .�: e,:�,.��:�k>� _,����==�w��. m
<br /> _ _ _ _ _-:'��;�.�.,.« ..;°�x:�—.s�€��a:'_...-t..,�i'.^_�:. ;�a�3x?.ue.�tR-T.'�k�5�'�!� . ,._ 'i'b'.�':"
<br /> Contractor Company i-�` k �
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address , a/ �� � 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
<br /> License#
<br /> OTHER
<br /> Company
<br /> Signature Registered Y/N Fee Ci�rrent Y/N
<br /> Address License#
<br />+
<br /> Directions:
<br /> Fill out application completely
<br /> Owner 8 Contracbor 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)seCs 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)
<br />
|