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�a�3-�ao-oo2o City of Zephyrhills Fire Fax-813-780-0021
<br /> ► Permit Application
<br /> Date Received __� Phone Contact for Permit �����_�
<br /> �.0 ___._..__�..._Y � - _._. __„�..._,�_..�..�.._..._...��..._,. - -�--- -
<br /> Ovmers Name � ) I� S' � �Cp/�v�v1� ��3�7'1 �7✓� Owner's Phone Number s/3 ��Y 'j(��
<br /> Ovmers Address / 3 �� (�^ /`jL.v� ���� �li� �L J ,j�
<br /> Fee Simple Titleholder Name � Titleholder Phone Number � � �
<br /> Fee Simple Titleholder Address
<br />� t�V..__��. - - - �a�___.._ __ _ -�E
<br /> Job Address Lot# ��
<br /> Sub Division Parcel#
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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 Burn � Hood Installation
<br /> � Emergency 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 ����
<br /> tr y emi �n t er �,
<br /> Sprinkler ❑ ❑ �, � � Recreational Bum
<br /> Fire Alarm g ❑ � ❑ � � 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 /> � FlammableApplication-ANNUAL Valuation of Project
<br /> � Fuel Tanks
<br /> Q O r:
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<br /> Contractor Company S/1,� C t
<br /> Signature Registered Y/N Fee Current Y/fV
<br /> Address License#
<br /> ELECTRICIAN Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> PLUMBER 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 Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
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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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