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<br />.? 13c780-0020 <br /> <br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />City of Zephyrhills Fir€ <br />Permit Application <br /> <br /> <br />P4:!> VO <br /> <br />Fee Simple Titleholder Name <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Im!:l';, <br /> <br />- <br /> <br />tV1 ~ 1Jp <br /> <br />Fax-813-780-0021 <br /> <br />&'7:>1(, <br /> <br />&#-/1 81vo <br /> <br />2~hy r I., (15 /~-- L <br />. I Parcel # <br /> <br />Phorie Contact for Permit <br /> <br /> <br />11732 115",)// 1 <br /> <br />Owner's Phone Number <br /> <br />'313 <br /> <br />FL <br /> <br />35J'I1 <br /> <br />Titleholder Phone Number <br /> <br />II <br /> <br />II <br /> <br />"ffiH~'~ <br /> <br />I Lot# <br /> <br />"3":5 5""f' / <br />I <br /> <br />Sub Division <br /> <br />~ ~~I~:~~"~II~" <br /> <br />D Other: <br />Contractor ! /l -' / <br /> <br />Signature . ~ <br /> <br />Address <br /> <br />ELECTRICIANI <br />Signature . <br /> <br />Address I <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br />Signature <br /> <br />Address I <br /> <br />OTHER <br />Signature <br />Address <br />Directions: <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br />Comm Exhaust Kitchen Hood/Duct <br />Controlled Bum <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />~~~~ <br />Sprinkler 0 0 0 0 L-J <br />Fire Alarm 0 0 0 0 C:=J <br />Hood Cleaning 0 0 0 0 C:=J <br />Hood Suppression 0 0 0 0 c=J <br /> <br />Fire Pumps <br /> <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />D Fumigation Tent <br />D Hazardous Material (Tier II or RQ Facility) ANNUAL <br />D Hood Installation <br />D LP/N~tural Gas-Installation <br />D LP/Natural Gas-ANNUAL Sale <br />~Iaces of Assembly-ANNUAL <br /> <br />D Recreational Bum <br />D Sparklers <br />D Sprinkler System Installations <br />D Standpipes (Sprinkler Sys) <br />D Torch RoofingfTar Kettle <br />D Waste Tire Storage ANNUAL <br /> <br />Valuation of Project <br /> <br />f1{ ,t~ <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br /> <br />Company <br /> <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <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 />