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<br />813-78D-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 />Fee Simple Titleholder Name <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />- <br /> <br /> <br />Fax-813-780-0021 <br /> <br />Phone Contact for Permit <br /> <br />( / rC(~To'( ..5l1.J~hly ) <br />I <br /> <br />'" <br /> <br />I J? 1.3 117?~ Il~t/O I <br />L/. <br />I II II I <br />I <br />I Lot# I <br />J <br /> <br />Parcel # <br /> <br />~ ~:~, ~:~'MmIlOOM <br /> <br /> <br /> <br />D Other: ~i ~ ,,111 w-~.,,' _ __ <br /> <br />~i:~~~~::r ! ~ ~ I ~:;:~:d <br /> <br />Address! 5/17/ WWAre~$ AV-e."ll1tIJfP<) 1::'Lj~~3J <br />ELECTRICIAN <br />Signature <br />Address I , <br /> <br />I <br />I <br />I <br />I <br />I <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 /> <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />~~~~ <br />Sprinkler D 0 0 0 L--1 <br />.0 0 0 )(.C=:J <br />Do ooC=:J <br />DoooC=:J <br /> <br />Fire Alarm <br /> <br />Hood Cleaning <br /> <br />Hood Suppression <br /> <br />Fire Pumps <br /> <br />Fire Works <br /> <br />Flammable Application- ANNUAL <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />o <br />D <br />D <br /> <br />Fumigation Tent <br />Hazardous Material (Tier" or RO Facility) ANNUAL <br />Hood Installation <br />LP/Natural Gas-Installation <br />LP/Natural Gas-ANNUAL Sale <br />Places of Assembly-ANNUAL <br /> <br />Recreational Bum <br /> <br />Sparklers <br />Sprinkler System Installations <br />Standpipes (Sprinkler Sys) <br /> <br />Torch RoofinglTar Kettle <br />Waste Tire Storage ANNUAL <br /> <br />Valuation of Project <br /> <br />PLUMBER <br /> <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br />Signature <br /> <br />Address I <br /> <br />OTHER <br /> <br />Signature <br /> <br />Address <br /> <br />License # <br /> <br />r:A:l2I5 t" C U l" 1~5J ,{,l/JC~~I <br />~FeeCurrent ,~~_ <br />I Ert?Ol?I/;)9 I <br /> <br />I Y I N I Fee Current Y I N I <br />I I <br /> <br />I Y I N I Fee Current <br />I <br /> <br />I Y I N I Fee Current <br />I <br /> <br />I Y /N <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />Y/N <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />Y/N <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />License # <br /> <br />Directions: <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 />