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<br />813-780-0020 <br /> <br />Date Re"eived <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />City of Zephyrhills Fir-e <br />Permit Application <br /> <br /> <br />Phone Contact for Permit <br /> <br />I ~~~~h~~ /t:j::~;:I(t~ I ~,Phad_' <br /> <br />I I Titleholder Phone Number I <br />I <br /> <br />Fee Simpie Titleholder Name <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />1S~~'fflj;~m <br /> <br />I Lot# <br /> <br />II <br /> <br />Sub Division <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />PLUMBER <br /> <br />Signature <br />Address I <br />MECHANICAL! <br />Signature <br />Address I <br /> <br />OTHER <br /> <br />Signature <br /> <br />Address <br />Directions: <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 ~ 0 0 lA L-J <br />Fire Alarm 0 0 0 0 C:=J <br />Ooooc=J <br /> <br />Ooooc=J <br /> <br />Hood Cleaning <br /> <br />Hood Suppression <br /> <br />Fire Pumps <br /> <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />o <br />o <br />o <br />o <br />o <br />o <br />D <br />D <br />D <br />D <br />o <br />o <br /> <br />Parcel # <br /> <br />Fumigation Tent <br />Hazardous Material (Tier II or RQ 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 />Torch Roofing/Tar Kettle <br />Waste Tire Storage ANNUAL <br /> <br />[lJ-ef'XJte ~ <br />~. <br /> <br />Valuation of Project <br /> <br />Company <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 />Company <br />Registered <br /> <br />License # <br /> <br />~, <br /> <br />1 JltWl~ <br /> <br />IJ <br /> <br />J <br />I <br /> <br />IQN <br />I <br /> <br />I Y/N <br />I <br /> <br />I Y/N <br />I <br /> <br />I Y/N <br />I <br /> <br />I Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />~ ~~:~~~~".~~oo <br /> <br /> <br />D Other: I <br /> <br />~~~::::r i~~ . ! <br /> <br />Address 135"3/ KE.lls-fon~ /l.rJ 7 Art.lon VJtJ~,j FL I <br />ELECTRICIAN <br />Signature <br />~~I I <br /> <br />I <br />I <br />I <br />I <br />I <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Fee Current <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 />