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ai3aso-oo2o City of Zephyrhills Fire Fax-813-780-0021
<br /> Permit Application
<br /> Date Received 2 2 � t L�^----�„4..4G`—°�,-�
<br /> Phone Contact for Permi
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<br /> Owner's Name � �/ �ti/L h� l Owner's Phone Number � � �
<br /> Owner's Address � � ���� (�p�� �(/�`'
<br /> Fee Simple Titleholder Name Titleholder Phone Number � � �
<br /> Fee Simple Titleholder Address � 1
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<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 Places of Assembly-ANNUAL
<br /> � try emi n t er• � � Z
<br /> 5gSprinkler � ❑ ❑ ❑ � Recreational Burn �/
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<br /> Fire Alartn � ❑ ❑ ❑ � � Sparklers
<br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations
<br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys)
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<br /> Fire Alarm Installation � Torch Roofing/Tar Kettle
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> � Fire Works
<br /> � FlammableApplication-ANNUAL D(J� �° 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 Current Y/N
<br /> Address License#
<br /> MECHANICAL Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> OTHER � � � Company GG�ct � =Cf2nNiC �r/13.�=
<br /> Signature r' Registered Y/N Fee Current Y/N
<br /> Address ��j/ ����t.� !�� L FOoo/U lo _ _
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<br /> icense
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<br /> Directions:
<br /> Fill out application completely.
<br /> Owner 8 Contractor sign back of application,notarized(O,copy of signed contract with owner)
<br /> If over$2500,a Notice of Commencement is required(Me hanical work over$5000)
<br /> Supply two(2)sets of drawings with applicable document tion
<br /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com)
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