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<br /> ; t�+13-780-0020 ity of Zephyrhills Fire Fax-813-780-0021
<br /> Z. - =� Permit Application
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<br />, Date Received y 1 — 2 Z— 1 5 Phone Contact for Permit ��2, �6� 7,�
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<br /> Owner's Name C.kv t�c.� � c��,5-�-- Owner's Phone Number � � �
<br /> Owner's Address � �L S'}S�o�
<br /> Fee Simple Titleholder Name Titleholder Phone Number � � �
<br /> Fee Simple Titleholder Address 1
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<br /> �ob Aad�ess 5r��� �� ���' ps'f'��� ' �ot# �
<br /> Sub Division Parcel#
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<br /> � Bio-Ha7ard 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 � Places of Assembly-ANNUAL
<br /> r y emi n t er
<br />' Sprinkler � ❑ ❑ � Recreational Bum
<br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers
<br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations
<br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkter Sys)
<br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> � Fire Works
<br /> � FlammabieApplication-ANPIUAL Valuation of Project
<br /> � Fuel Tanks
<br /> Q other:
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<br /> Contractor /'' � Company
<br /> Signature [� � � 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 Registered Y/N Fee CuRent 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,notarize (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 docu entation
<br /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http:/lappraiser.pascogov.com)
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