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813-780-0020 Ciry of Zephyrhills Fire Fax-813-780-0021
<br /> � � Permit Application
<br /> Date Received Phone Contact for Permit z
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<br /> Owner's Name (,�Z cvi✓ta ivitN Owner's Phone Number � � �
<br /> Owner's Address
<br /> Fee Simple Titleholder Name Titleholder Phone Number � � �
<br /> Fee Simple Titleholder Address
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<br /> Job Address �J �� Y DL./� d',�6L� � '�`�L�°A � --�p�/�-��� P Lot# � �
<br /> Sub Division Parcel#
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<br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent
<br /> � Comm Exhaust Kitchen HoodlDuct � Hazardous Material(Tier II or RQ Facility)AMNUAL
<br /> � Controlled Burn � Hood Installation
<br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation
<br /> � Emergency Generator>30 kw � LP/Natural Gas-AtdNUAL Sale
<br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL
<br /> t y emi �n t er
<br /> Sprinkler � ❑ ❑ ❑ � Recreational Burn
<br /> Fire Alarm � ❑ ❑ O � � Sparklers
<br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations
<br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys)
<br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle �
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> � Fire Works
<br /> � Flammable Application-ANNUAL L9� Valuation of Project
<br /> � Fuel Tanks
<br /> 0 Other:
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<br /> Contractor � Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> IAddress License#
<br /> ELECTRICIAN Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> IIPLUMBER Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> MECHANICAL Company
<br />' Signature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> OTHER r Company S �GJGi �' CL �2.1i�,1'c: t�s �
<br /> Signature Registered Y/N Fee Current Y/N
<br /> � Address / �/,rR, Z G,� Cr� G License# ��Q a Q �p
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<br /> Directions:
<br /> Fill out application completely
<br /> Owner 8 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 documentation
<br /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com)
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