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813-780-0020 � ity of Zephyrhills Fire Fax-813-780-0021
<br /> Permit Application
<br /> Date Received �� ' l Phone Contact for Permit � �Z l N� �
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<br /> Owner's Name Q��+ � G o, r L-[� c�� � ,t CU i C Owner's Phone Number � � �
<br /> Owner's Address -6P �U � �� b(�U -Cd s
<br /> Fee Simple Titieholder Name Titleholder Phone Number � � �
<br /> Fee Simple Titleholder Address
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<br /> Job Address N�d _l D � R,�/( 1 V� Lot# �
<br /> Sub Division i Parcel# r3 S''z.��� -Q —O
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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 � r(.
<br /> ' �t�
<br /> tr y emi t er �
<br /> Sprinkler � ❑ ❑ � � Recreational Burn �
<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 /> � FlammableApplication-ANNUAL �Op , � 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 /N Fee Current Y/N
<br /> Address ,s (, � C f I .� a F License# 4 �](o(�
<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&Contractor sign back of application,notarized(Or,c py of signed contract with owner)
<br /> If over$2500,a Notice of Commencement is required(Mech nical work over$5000)
<br /> Supply two(2)sets of drawings with applicable documentati n
<br /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com)
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