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a�,�-7so-oozc City ofZephyrhills rir:e Fax-8�3-�8o-oo�i
<br /> , - Permit Application
<br /> Dai Received � Phone Contactfor Permif
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<br /> Owner's Name i`ti�r���}� � y'Y 7- �Q�� Owner's Phon=Number � r�� �
<br /> Owner's Address , (�, 4 �1�Y1 � �� (� � a 3�
<br /> Fe=Simple Titlehold=r Name Titleholder Phone Number C� � �
<br /> Fee Simple Titl=hold=r Address
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<br /> Job Address .��1 c�� y���-�'1 � � L - Lot€ �
<br /> Sub D�v�sion Parcel�
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<br /> � Bio-Hazard Waste Storage-ANNUAL � Fumiaation Tent
<br /> � Comm Exhaust Kiichen Hood/Duct , � Hazardous Material(Tier II or RQ Facility)ANNUAL
<br /> � Controlled Burn � Hood Installation
<br /> � cmergency Generetor<30 kw � LP/Natural Gas-Insta.11ation
<br /> � Emergency Genere'tor>30 kw � LP1Natural Gas-ANNUAL Saie
<br /> � Fire Protection Mainfenance-ANNUAL � Places of Assembiy-ANNUAL
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<br /> Sprinkler G ❑ p � � Recrearional8um �
<br /> Fire Alarm � ❑ p ❑ C� � Sparklers ��/��
<br /> Hood Ci=aning � � ❑ ❑ �� � Spnnkler System fnstallations �
<br /> Hood Suppression � p � ❑ � � Standpipes(5prinkler Sys)
<br /> � Fire Alarm Instalfation � Torch Roofing/Tar Kettle
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> � Flammable Applic2tion-ANNUAL Valuation of Project
<br /> � Fuel Tanks
<br /> � Other: '
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<br /> Contractor
<br /> Company
<br /> Signature Registsred Y 1 N Fee Current Y/N
<br /> Address �
<br /> License� �
<br /> ELECTRICIAN Company
<br /> Sigraiure Registered Y/N Fee Current Y/N
<br /> Address
<br /> License�
<br /> PLUMB�R
<br /> Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Addr=ss
<br /> Licensa# �
<br /> MECHANICAL Company
<br /> Signature Registered Y/N 'ree Current Y/N
<br /> Address �
<br /> License� �-
<br /> OTH�R Company - =2 - -�,�% ,Fl�T� r .7 G
<br /> Signatur= � '/�� �^�� Registered f�""'" "'FE /(�j
<br /> Aadr ss �
<br /> .:>, - ( G �"� �G 7 7 ? License�� `'
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<br /> Directions: .,:. .....w. ` . , x
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<br /> Fill out aoplicaiion completely. ,
<br /> Owner&Contractor sign back o`application,notanzed(Or,copy of signed contract with owne
<br /> If ove:�250G,a Notice o�Comm=ncemen:is required(Mechanica!work over W5000)
<br /> Supply iwo(2)sets of drawings with applicable documentaiion �
<br /> Allow 1 C-'14 days for review after submiYal date. Parcel rt-obtained from Properiy Tax"Nc�lipe htt /,a
<br /> p:� pp-aiser.pzs^ _ com)
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