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s�saao-oo2o City of Zephyrhills Fire Fax-813-780-0021
<br /> Permit Application
<br /> Date Rece�ved Phone Contact for Permit �
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<br /> Owne�s Name 6-/ O O 2 Ownei's Phone Number �� �V✓ {k+46
<br /> Owners Address � �U Z Q h r ��� F�
<br /> Fee Simple Titleholder Name �. TiUeholder Phone Number � � �
<br /> Fee Simple TiUeholder Add�ess
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<br /> Job Address � � 1 U �e ��r���✓ Lot# �
<br /> Sub Division Par�el#
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<br /> � Bio-Hazard Waste Storege-ANNUAL a Fumigation TeM
<br /> a Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL
<br /> � Controlled Bum � Hood Installation
<br /> � Emergency Generator<30 kw � LPMatural Gaslnstallation
<br /> � Emergency Generator>30 kw � LP/Natural GasANNUAL Sale
<br /> � Fire Protedion Maintenance-ANNUAL � Places of Assembly-ANNUAL
<br /> � �� �
<br /> Sprinkler ❑ ❑ ❑ � � Recreadonal Bum
<br /> Fire Alartn ❑ ❑ �f � � Sparklers
<br /> Hood Cleaning ❑ ❑ ❑ � � Sprinkler System Installations
<br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys)
<br /> aFire Alarm Installation � Tor�ch Roofing/Tar Kettle
<br /> Fire Pumps � Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> Flammable Application-ANNUAL r Valuation of Project
<br /> Fuel Tanks
<br /> Q Other:
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<br /> CoMractor ^ Company
<br /> Signature �-C- Registered Y/N Fee Current Y/N
<br /> Address Lice�se#
<br /> ELECTRICIAN Company J t
<br /> Signawre Registered Y/N Fee CurreM Y/N
<br /> Address License# �
<br /> PLUMBER Company
<br /> Signature Reyiscered Y/N Fee cumern Y/N
<br /> Address License#
<br /> MECHANICAL Company
<br /> Signature Registered Y/N Fee Currertt Y/N
<br /> Address License it �— �
<br /> OTHER Company
<br /> Signature Register�ed Y/N Fee Currerrt Y/N
<br /> Address ., ` ._ . License#
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<br /> Directions: � , , � _.� .
<br /> - Fill out applieation completely.
<br /> Ow�er&ContraCtor sign back of application;notarized(Or,copy of signed contrad with owner)
<br /> If over�2500;g Nottce'bf�omm�nC�emeltt i8 required(Mechanical work over$5000)
<br /> Su�ly two(2)sets of drawings with applipble 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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