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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021
<br /> Permit Application
<br /> Date Received �--Z�('� Phone Contact for Permit �l�J� (� (� �j
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<br /> Owner's Name �d r, g ��� Owner's Phone Number � 7�Z Y�i��
<br /> Ovmer's Address �o�0 0�o ��� ��V� Z 1�`�l L '�j 3�'t-�,'�
<br /> Fee Simple Titleholder Name Titleholder Phone Number � � �
<br /> Fee Simple Titleholder Address
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<br /> Job Address �G�C..�� �
<br /> Lot#
<br /> Sub Division Parcel#
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<br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent
<br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL
<br /> � Controll�d Burn � Hood I�stallation
<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 (�`i
<br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum �
<br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers
<br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations
<br /> Hood Suppression � ❑ ❑ ,t9 �� � Standpipes(Sprinkler Sys)
<br /> � Fire Alartn Installation � Torch 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 Other:
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<br /> Contractor _
<br /> Company /�6 /C• `j�-,�� ���
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address P.O, p d ��, _3�fj 1j License#
<br /> ELECTRICIAN Company
<br /> Signature Registered Y/N Fee CuRent Y/N
<br /> Address 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 Current Y/N
<br /> Address License#
<br /> OTHER
<br /> Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License# r
<br /> Directions.
<br /> Fill out application completely
<br /> Owner 8 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://appraiser.pascogov.com)
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