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}13-7$0-Gv3o City of Zephyrhills Fire Fax-813-780-0021
<br /> Permit Application
<br /> �ate Received 1 C Zq 2 o t 3 Phone Contact for Pertnit �j 1 � 9�(o �-(�
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<br /> Owners Name t�b�'a v"1 1 � T�'"��I O Y� Ovmers Phone Number {� ( � ���
<br /> Owner's Address � �� � �r��� ���%L� 7 " i ..,, << -#1( �S��Z
<br /> Fee Simple Titleholder Name Titleholder Pho�e Number � � �
<br /> Fee Simple Titleholder Address
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<br /> Job Address • �GC. u�-�"` Lot# ��
<br /> Sub Division Paroel#
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<br /> � 4 Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent
<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 � LPlNaturai Gas-ANNUAL Sale
<br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL
<br /> �y emi �n er
<br /> Sprinkler � ❑ ❑ ❑ � Recreational Bum � , j/ � 3
<br /> Fire Alartn � ❑ ❑ O � � Sparklers JX ��Y!
<br /> -� �
<br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkier System Installations
<br /> Hood Suppression /� ❑ �' ❑ � � Standpipes(Sprinkler Sys) /;�
<br /> v/
<br /> � Fire Alartn Installation � Torch RoofinglTar Kettle � �
<br /> � 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 - Company F=�y.�, -; � 1✓' �,q�--
<br /> Signature ,�� Registered Y/N ee Current Y/N
<br /> Address c,� G.�r ` � . / < �' 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 /> MECHANICA Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> OTHER Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
<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 submittai date. Parcel#-obtained from Property Tax Notice(http:/lappreiser.pascogov.com)
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