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<br /> 813-780-0020 City of Zephyrhills Fire Fax-813-780-0021
<br /> Perm it�Application
<br /> Date Received � I Phone Contact for Permit `�_���
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<br /> Owner's Name OS'�j�A�S � -� ,�G�. I Owner s Phone Number � � �
<br /> Owner's Address Jr�� ,� � �� ,/� J'�7//S �����
<br /> Fee Simple Titleholder Name Titleholder Phone Number .� � �
<br />, Fee Simple Titleholder Address � 1
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<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 Bum � 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 I � Places of Assembly-ANNUAL
<br /> tr y emi n t er ��'p,2
<br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum (, v
<br /> Fire Alarm � ❑ ❑ � � � 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 /> I � FlammableApplication-ANNUAL Valuation of Project
<br /> � Fuel Tanks I
<br /> Q Other: �
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<br /> Contractor ' Company
<br /> Signature ,Q�/. Registered Y/N Fee Current Y/N
<br /> Address � License#
<br /> ELECTRICIAN Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address � License#
<br /> PLUMBER � Company
<br /> Signature I Registered Y/N Fee Curcent Y/N
<br /> Address � License#
<br /> MECHANICAL Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address � License#
<br /> OTHER i Company
<br /> Signature i Registered Y/N Fee Current Y/N
<br /> Address � License#
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<br /> Directions: I
<br /> Fill out application completely
<br /> Owner&Contractor sign back of application,notarized( r,copy of signed contract with owner)
<br /> If over$2500,a Notice of Commencement is required( echanical work over$5000)
<br /> Supply two(2)sets of drawings with applicable docume ation I
<br /> Allow 10-14 days for review after submittal date. Pa Icel#-obtained from Property Tax Notice(http://appraiser.pascogov.com)
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