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<br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />813-780-0020 <br /> <br />City of Zephyrhills Fir€ <br />Permit Application <br /> <br /> <br />Fee Simple Titleholder Name <br /> <br />I <br />13'i(~N <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />Cr( ~y I/wy' (f~ <br />. <br /> <br />1~1Jj <br /> <br />Fax-813-780-0021 <br /> <br />Phone Contactfor Permit <br /> <br /> <br />Owner's Phone Number <br /> <br />I @{ S 11"182.- II OB&> I <br /> <br />Titleholder Phone Number I <br /> <br />Parcel # <br /> <br />II <br /> <br />II <br /> <br />I Lot# <br /> <br />Contractor <br />Signature <br />Address <br /> <br />ELECTRICIAN <br />Signature <br /> <br />Address I <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANICAL] <br />Signature . <br /> <br />Address ~ <br /> <br />OTHER <br />Signature <br /> <br />~ <br /> <br />D <br /> <br />D <br />D <br />D <br />D <br />D <br />D <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 /> <br />Fire Alarm 0 0 0 0 c=J <br /> <br />Hood Cleaning 0 0 0 0 c=J <br /> <br />Hood Suppression 0 0 0 0 c=J <br /> <br />Fire Alarm Installation <br /> <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />D Fumigation Tent <br />D Hazardous Material (Tier II or RQ Facility) ANNUAL <br />D Hood Installation <br />D LP/Natural Gas-Installation <br />D LP/Natural Gas-ANNUAL Sale <br />I:RI Places 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 />Other: <br /> <br />L-", <br /> <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br /> <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br /> <br />Registered <br /> <br />License # <br /> <br />Company <br /> <br />Registered <br /> <br />License # <br /> <br />;:A/Jib fjApTi~r C JWf(h, <br />Y I N Fee Current I Y I N <br />I <br /> <br />Y/N Fee Current Y/N I <br />I <br /> <br />Y I N Fee Current <br /> <br />Y/N <br /> <br />Y I N Fee Current <br /> <br />Y/N <br /> <br />Y I N I 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. Parcel # - obtained from Properly Tax Notice (http://appraiser.pascogov.com) <br />