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8?3-780-OGZO Ciiy of Zephyrhills Fire Fax-813-780-0021
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<br /> Permit Appiication
<br /> Date Received I Phone Contact for Permit
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<br /> ree Simple Titleholder Name Titteholder Phone Number C� � �
<br /> Fee Simple?itleholder Address
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<br /> Job Address y� �'T�RN� � L �E l�H�'v� 5 �L �j c.3,j�/a Lot# C�
<br /> Sub Drvis�on Parcel# ��j a� ) ����� �L-�
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<br /> Bio-Hazard Waste Storege-ANNUAL � Fumigation Tent
<br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ racility)ANNUAL
<br /> � Controlled Bum � Hood Instalfation
<br /> � Emergency Generator<30 kw � LP/IVatural Gas-Installation
<br /> � Emergency Generetor>30 kw � LP/Natural Gas-ANNUAL Sale
<br /> �, Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL
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<br /> Sprinkler � ❑ ❑ � Recrea6onal Bum '�%]�
<br /> Fire Alarm � p p � � � Sparklers �� V �
<br /> Hood Cleaning � u C ❑ � � Sprinkler System fnstallations
<br /> Hood Suppression � G ,_ ❑ a Standpipes(Spnnkfer Sys)
<br /> � Fire Alartn Installation � Torch Roofing/Tar Kettle
<br /> � Fire Pumos � Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> � Flammabie Appiication-ANNUAL
<br /> � Vatuation of Project
<br /> Fuel Tanks
<br /> Q Other:
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<br /> Contrector
<br /> Company
<br /> Signature Registered Y I N Fee Current Y/N
<br /> Address
<br /> License#
<br /> ELECTRICIAN
<br /> Company
<br /> Signature Registered Y!N Fee Current Y/N
<br /> Address
<br /> License#
<br /> PLUMBER
<br /> Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address
<br /> License# �--
<br /> MECHANICAL
<br /> Signature
<br /> Company
<br /> Registered Y/N Fee Current Y/N
<br /> Address
<br /> License#
<br /> OTHER Company � /
<br /> Signature � "�f ���J� �Z -z'u�C= �i�C>Tc�>-z 1,z�G
<br /> Registered /N ` Fee(:urrent ,� /N
<br /> Address I � n�n�C 5 L�2 � �
<br /> ;�.yl _..�;. GG FL 377 L
<br /> icense#
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<br /> Directions. �w� �� d�.�a�
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<br /> Fill out application completely. "��x�F
<br /> Owner&Contractor sign back of application,notarized(Or,copy of signed contrect with owner)
<br /> I`over 52500.a Notice of Commencement is required(Mechanica!work over$5000)
<br /> Suoply two(2)sets of drewings with applicable documentation
<br /> Allow 1 C-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http:/rapprelser.pascogov.com)
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