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' s�s'-7so-oo20 • City of Zephyrhills Fire � Fax-813-780-0021
<br /> Permit Application
<br /> Date Received rmit
<br /> Phone Contact for Pe _�.�
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<br /> Owners Name D� Z e h/ Owners Phone Number � � �_]
<br /> Owners Address 5,33.5?�fh�5 i —'L O�
<br /> Fee Simple Titleholder Name Titleholder Phone Number � � �
<br /> Fee Simple Titlehalder Address
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<br /> Job Address {., '\'(`h,� S' �L �Lotr# ��
<br /> Sub Division Parcel# � - - ^ (���D.. � �'6
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<br /> � 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 � LPMatural Gas-Installation
<br /> � Emergency Generator>30 kw � LPMatural Gas-ANNUAL Sale
<br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL
<br /> try emi Anl ther
<br /> Sprinkler � ❑ ❑ 1� � Recreational Bum
<br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers
<br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations
<br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys)
<br /> � Fire Alarm Installation � Torch RoofinglTar Kettle
<br /> � Fire Pumps � Waste Tire Storage AN�VUAL
<br /> � Fire Works
<br /> � Flammable Application-ANNUAL Valuation of Project
<br /> � Fuel Tanks
<br /> � Other:
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<br /> �C ntractor Company �} V �� � �
<br /> gnature Rzgisterzd N Fee Current Y/N
<br /> Address 1 LicenseTM �� �7)� � a
<br /> ELECTRICIAN Company
<br /> Signature Registered Y/N Fze Current Y/N
<br /> Address License m
<br /> PLUMBER Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License�
<br /> ti1ECHAN ICAL Company
<br /> Signature P.egister2d Y/N Fee Current Y/N
<br /> Address Licensa m
<br /> OTHER Comp2ny
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address Licensz�
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<br /> Girections:
<br /> Fill out application completely.
<br /> Owner&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 docum2ntation
<br /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Nctice(http://appraiser.pascogov.com)
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