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81�-78C-0020 City of Zephyrhills Fire Fax-813-7g0-�021
<br /> Permit Application
<br /> Date Received , Phone Contact for Permit
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<br /> Owner's Name Lp� �jJN y�' � —�,v5 i % Owner's Phone Number � C� ��
<br /> Owner's Address ('G ELL f G' i(JT2 Y�`J 7�a lj j /�1"�,J�C�/�D LSS `'7j� ,7.9 `al���`JC�3
<br /> Fee Simole Titleholder Name Titfeholder Phone Number � �� ��
<br /> Fee Simpte�fitlenolder Address
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<br /> Job Address 3 D� ��:"�� �j',� � t� Lot# �
<br /> Sub Droision Parcel# �j ,�� �l (`JC�/L
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<br /> Bio-Hazard Waste Storege-ANNUAL � Fumigation Tent
<br /> a Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL
<br /> � Controlled Bum � Hood Installation
<br /> � cmergency 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
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<br /> Sprinkler �- O G Recreational Bum
<br /> Fire Alarm � p ❑ ❑ � � Sparklers
<br /> Hood Cleaning � ❑ ❑ ❑ � Sprinkler System Installations
<br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys)
<br /> � Fire Alarm Instaltation � Torch Roofing/Tar Kettle
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> � Flammable Application-ANNUAL
<br /> Valuation of Project
<br /> Fuel Tanks
<br /> � Other:
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<br /> ConVactor - �� ����
<br /> Company
<br /> Signature Regisiered Y/N Fee Current Y!N
<br /> Address
<br /> License#
<br /> ELECTRICIAN
<br /> Company
<br /> Sigrature 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 Company
<br /> Registered Y/N Fee�urrent Y/N
<br /> Adtlress
<br /> License#
<br /> OTHER � �- � I
<br /> Signature � �_ �� t--�—�_� Company �I"-L�� � " �j.�'oiGc=i1o,c� �,�C
<br /> Registered �Y�N � Fee Current /Y�N
<br /> Address � � C�y, —
<br /> <.'�� =�:.- ... �s 3-s»D License# � ' `a
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<br /> Directions: ,� _.. .�.,���_., � �� �_r s-,.:�:,_ _
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<br /> Fili out applicaiion compietely. '�'""'
<br /> Owner&Contractor sign back of application,notarized(Or,copy of signed contrect with owner)
<br /> Ir over�2500,a Notice o`Commencement is required(Mechanical work over$5000)
<br /> Supply two(2)sets of drawings with applicable documentation
<br /> Allow 1C-14 days for review after submittaf date. Parcel#-obtained trom Pro ert Tax Notice ntt /ia
<br /> P Y ( p: ppreise;.pascogov.com)
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