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<br />1 ~CJiJI ( <br /> <br />Fax-813-780-0021 <br /> <br />,J-Q020 <br /> <br />City of Zephyrhills Fi~t ..)t'1~ <br />Permit Application <br /> <br />Pho~e Contact for Permit <br /> <br /> <br />,Ived <br /> <br />er'S Name <br /> <br />,er's Address <br /> <br />51'10 <br />Simple Titleholder Name <br /> <br />Simple IIt1eholder Address <br /> <br />, AddresS <br /> <br />J Division <br /> <br />D Blo-Hazard Waste Storage - ANNUAL <br />D Comm Exhaust Kitchen Hood/Duct <br />D Controlled Bum <br />D Emergency Generator < 30 kw <br />D~ Emergency Generator> 30 kw <br />~ Fire Protection Maintenance - ANNUAL <br />-' . ~~~~ <br />Sprinkler 0 0 0 0 L-...j <br />Fire Alarm 0 0 ODD <br /> <br />Hood Cleaning 0 0 oDD <br /> <br />Hood suppression ~ 0 O)l.Cl <br />Fire Alarm Installation <br />Fire Pumps <br />FlreWorl<s <br />Flammable Application- ANNUAL <br /> <br /> <br />Contractor <br />Signature <br /> <br />Address <br /> <br />~lIa:~:ress t <br />PLUMBER t <br />Signature E <br /> <br />Address <br /> <br />MECHANICAL[ <br />Signature . [ <br /> <br /> <br />--t <br />OTHER <br />Signature <br /> <br />Address E <br /> <br />Directions: <br /> <br />o <br />D <br />D <br />8 <br /> <br /> <br />o Recreational Bum <br /> <br />t 1 Sparklers <br />o <br />8 <br />r <br /> <br /> JT II <br /> JI ][ <br />~ .,~ -' Lot # <br /> <br /> <br />Fumigation 1"ent <br />HazardoUS Material (Tier II or RQ Facility) ANNUAL <br />Hood Installation <br />LPlNatural Gas-Installation <br />LPlNatural Ges-ANNUAL Sale <br />Places of Assembly-ANNUAL <br /> <br />Sprinkler system Installations <br />Standpipes (Sprinkler Sys) <br />Torch RoofinglTar KeWe <br />Waste Tire Storage ANNUAL <br /> <br />] <br /> <br />Valuation of Project <br /> <br />I <br />\ <br />J <br />1 <br />J <br />1 <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />K~~~~~~ <br />r.N~;:~~ <br /> <br /> <br />f Y/N I Feeeunont I <br /> <br /> <br />E Y IN J <br /> <br />\ <br />r <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y/N J <br />J <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Fee Current r Y / N T <br />1 <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y / N T Fee Current I <br />-- : <br /> <br />YINJ <br />J <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. Parcel # - obtained from Property Tax Notice (http://appraiser.pascogov.com) <br />