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<br />/ &c .~}m ,p \ <br />!313-780-00~ ~~~_ ~~~'_ ~ ~ City of Zephyrhills Fire Fax-813-780-0021 <br />- - Permit Application . T C/YY'\ <br />~~~~;'e'imt_$Bl"*"~::":'::j~:::~' ,Z""ih,"1_--"':~f;~~.31::2Jj*"~~.:L0U,,~2:LI <br />/)i ~? ~J.q I Owner's Phone Number I II I I I <br />~- - ~ <br /> <br />I <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br /> <br />I <br /> <br />Fee Simple, Titleholder Address I <br /> <br />~-~---r'8<'Dll~G=~ <br />Job Address 7 Z 5 . <br /> <br />I <br /> <br />I Titleholder Phone Number <br /> <br />II <br /> <br />I <br />I <br />b;?S-~Yf:--r~-ftl <br />13~ZJ9u~g~/o I <br />t:u r t:) <br /> <br />, <br />Fee Simple! Titleholder Name <br /> <br />Sub Division <br /> <br />Be:. <br /> <br />-- <br /> <br />z;~~. <br /> <br />Parcel # <br /> <br />o <br />o <br />D <br />D <br />o <br />o <br /> <br />o <br />o <br />D <br />D <br />D <br />o <br /> <br />Contractor <br />Signature <br /> <br />Address I <br /> <br />ELECTRICIAN <br />Signature I <br /> <br />Address I <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br />Signature . <br /> <br />Address I <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br />Comm Exhaust Kitchen Hood/Duct <br />Controlled Bum <br /> <br />D Fumigation Tent <br />D Hazardous Material (Tier" or RQ Facility) ANNUAL <br />D Hood Installation <br />D LP/Natural Gas-Installation <br />D LP/Natural Gas-ANNUAL Sale <br />D Places of Assembly-ANNUAL <br />D Recreational Bum <br />D Sparklers <br />a Sprinkler System Installations <br />D Standpipes (Sprinkler Sys) <br />D Torch Roofing <br />D Waste Tire Storage ANNUAL <br /> <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />Sprinkler D <br />Fire Alarm D <br />Hood Clean/Suppression D <br />Fire Alarm Installation <br /> <br />t-.lO C- ~ O~ p.~~~ <br /> <br />s~ -h:;; ~I ,,1'") <br />\C(Z2-/67 <br /> <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />I '3rOCB <br /> <br /><A- <br /> <br />Valuation of Project <br /> <br />Other: <br /> <br /> <br />N <br />Uq ZS3 20ro/U:0 I <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y I N Fee Current Y I N <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y I N I Fee Current I Y I N <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y I N I Fee Current Y I N <br /> <br /> <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y I N , Fee Current <br /> <br />Y/N <br /> <br />Fill out application completely. <br />Owner & Contractor sign back of application, notarized (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 documentation <br />Allow 10-14 days for review after submittal date. <br />