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s�9-780-002o City of Zephyrhills Fire Fax-813-780-0021
<br /> Permit Appiication
<br /> date Received �T�"'f `J � Phone Contact for Permit fJ"'/3 ..�`7r �lQ�
<br /> .,.���-�� :��.e..,_�,.��;.:,� ��a,��r,.•�r�.:�..� �•�..;��,�����,.,.�.�. .�-_...._ �-
<br /> Owner'sName • t .,��� Owner's Phone Number �� �� ��
<br /> Uwner's Address �6 j �n�t er R� �( 'Y���•'e ib ,�'� ?3,5�y
<br /> Fee Simple Titleholder Name Titlehalder Phane Number �� C� ��
<br /> Fee Simple Titleholder Address
<br /> �;�.���- ;fi:-.,�,�. _ .,;� �s.�;�;.�: � ._.=�-.-
<br /> JobAddress 5 S3� �-,.i! �1,,,,J Z.� ti �1,,�lrs 1 33�'y �, �ot# ��
<br /> Sub Division Parcel#
<br /> �`-'`�'=->'1:��'s'�d:'x':!'1:.bpYV'7d8.e,'. . .. _.. �$;'r < . _ A��7'..M?44!C*S. _ . TH"'k"49-'Al.B1.'�`"y�y^�-�^,"'be-�!,;G'�{";`-��'-.p'a�':f+E-�^�wm.--_fa.$61°..�.T.'.�'�!@��P+?,-^�� _ _
<br /> � Bio-Hazard Waste Storage-ANNU/U. o Fumigation Tent
<br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL
<br /> oControlled Burn o Hood Installatian
<br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation
<br /> � Emergency Generator>3Q kw � lP/Natural Gas-ANNUAL Sale
<br /> � Fire Protectian Maintenance-ANNUAI � Places of Assembly-ANNUAL
<br /> rly emi � er f{��/ �j,
<br /> Sprink�er � ❑ CI ❑ � � Recreatianai Bum l ��
<br /> Fire Alarm � O ❑ ❑ � � Sparkiers
<br /> Hoad Cleaning �.. ❑ ❑ � � Sprinkfer System instailations
<br /> Hood Suppression ❑ ❑ � � Q Standpipes(Sprinkler Sys)
<br /> � Fire Alarm Installation � Torch RoofinglTar Kettle ( ��
<br /> � Fire Pumps Q Waste Tire Storage ANNUAL �l
<br /> Fire Works
<br /> � Flammable Application-ANNUAL ��—� Valuation of Project
<br /> � Fuel Tanks
<br /> Q Other:
<br /> �,,: . -: x��..:,n.<��.,�:�:�-,��ab<�=�� . :.��:��•;���-,��.��.��r��;,����,�,.a.,.�,���s<:;,��:��.�--� _ �,- -
<br /> Contractor /��L�'�" Company c, Pe ��Q a <i.•
<br /> Signature �� Registered Y!N Fee Cu eM Y i N
<br /> Address ticense#
<br /> El.EC7RICIAN Company
<br /> Signature Registered Y 1 N Fee Current Y 1 N
<br /> Address License#
<br /> PWMBER Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> MECHANICAI Company
<br /> Signalure Registered Y I N Fee Current Y I N
<br /> Address l.icense#
<br /> OTHER Campany
<br /> g;g�{�� Registered Y/N Fee Curcent Y/N
<br /> Address l'+cense#
<br /> F_ .-., . , .. - -
<br /> r�_ -.m..., . ..,..�: -._ _ :., ... .� ., ,.._.,� _.... „ w._,.,m.,. _, . . .._ s�_.._. . ......,. ._.. �. ... ,
<br /> Direetions:
<br /> Fill out application completely
<br /> Owner&Contractor sign back of application,notarized(Or,capy of signed contract with owner)
<br /> if aver$2500,a Notice of Commencement is required(Mechanicai work over$5404}
<br /> Suppiy twa(2)sets nf drawings with appi{cabie documentatian
<br /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com)
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