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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021
<br /> Permit Application
<br /> Date Received �f�Zq �(
<br /> Pho�e Contact for Permit �T(�j y96 b�6
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<br /> Owner's Name �o l�e.,,�, �ri�/�a.� Owner's Phone Number `B l 7� Sq6�
<br /> Owner's Address �a$�j (7-q I J� 2-���� t � 3J Stf z
<br /> Fee Simple Titleholder Name Titleholder Phone Number C� � ��
<br /> Fee Simple Titleholder Address
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<br /> Job Address �
<br /> Lot#
<br /> Sub Division Parcel#
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<br /> Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent .��T
<br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL
<br /> � Controlled Bum � Hood Installation
<br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation
<br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale
<br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL
<br /> � emi � er
<br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum
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<br /> Fire Alartn � ❑ O ❑ C� � Sparklers ��
<br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations
<br /> Hood Suppression � O ❑ � �� � Standpipes(Sprinkler Sys)
<br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> � Fire Works
<br /> � Flammable Appfication-ANNUAL Valuation of Project
<br /> Fuel Tanks
<br /> Q Other:
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<br /> __ ::rY '«qT��',4§"�,'��..fM" f�.. ��$`$.
<br /> Contractor - Company �'�/�-/T��` /� c
<br /> Signature Registered Y/N Fee C�urrent Y/N
<br /> Address p,7, ,(yp ,C,�,,�6 pi F�3�f6� 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 />�THER
<br /> Company
<br /> 5ignature Registered Y/N Fee CuRent Y/N
<br /> Address
<br /> License#
<br />�irections:
<br /> Fill out application completely
<br /> Owner&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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