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<br />813-780-0020 <br /> <br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />City of Zephyrhills Fife <br />Permit Application <br /> <br /> <br />Fax-813-780-0021 <br /> <br />Phone Contact for Permit <br /> <br /> <br />Owner's Phone Number <br /> <br />I 1/3 II r$l:z..114 >"2/1 <br /> <br />Titleholder Phone Number <br /> <br />II <br /> <br />II <br /> <br />Fee Simple Titleholder Name <br />Fee Simple Titleholder Address <br /> <br />~il <br /> <br />I Lot# <br /> <br />I <br /> <br />Job Address <br /> <br />~m.j~tJ1] r~~ <br /> <br />Parcel # <br /> <br />Sub Division <br /> <br />~ <br />D <br />o <br />o <br /> <br />Contractor <br />Signature <br /> <br />Address <br /> <br />ELECTRICIANI <br />Signature . <br /> <br />Address I <br /> <br />PLUMBER I <br /> <br />Signature <br />Address I <br />MECHANICALI <br />Signature <br />Address I <br /> <br />OTHER <br /> <br />Signature <br /> <br />Address <br /> <br />Directions: <br /> <br />~ <br /> <br />o <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 '5ll ~ 0 0 c=J <br /> <br />Hood Suppression 0 0 0 0 c=J <br /> <br />Fire Aiarm Installation <br /> <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />Other: <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />Fumigation Tent <br />Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> <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 />. ~ <br />~ rJ /.,-:zYJt <br />JuIJ . d_ <br /> <br /> <br />Sparklers <br /> <br />Sprinkler System Install a . s <br /> <br />Standpipes (Sprinkler S ) <br /> <br />Torch Roofing/Tar Kettle <br />Waste Tire Storage ANNUAL <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 />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />T~~1m:~ <br /> <br />I <br />~-PJ/W!i"""--~; <br /> <br />I <br /> <br /> <br />I Ci:JLQ-::t1::., ~ C~ <br />t:!i>1 ~ I Fe~ ~urrent I 61'1 N I <br />I I <br /> <br />I Y/N I Fee Current Y/N I <br />I I <br /> <br />I Y 1 N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <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 />