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<br />. 8'13-780-0020 City of.Zephyrhills Fire Fax-813-780-0021 <br />Permit Application <br />/ . <br />~;;e~,i=~a~~L-1:,-?~~""..~~~~~~;~~~I~~~_,~._,~~.JvI.".."--..,. <br />~~ r S~~Pf.e ."':(, hY) LI """e', Phone ,,,,,,be, I ~ I:>, Il7n II ~ /)1 <br /> <br />I <br />I <br /> <br />Fee Simple Titleholder Name <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />I Titleholder Phone Number I <br /> <br />II <br /> <br />II <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />~"$~dffill!l.lel~l!Immi~1li!1l"""", <br /> <br />"Xun~ <br /> <br />~-.._-",~(~~~ <br /> <br />I Lot# <br /> <br />Sub Division <br /> <br />Parcel # <br /> <br />(Utj I AII'lt::U t"KUIVI t"'KUt"'t::K I Y I AA NU II'-'t::) <br />.~. ~~'._~,~~~'1il'i!lDlllllIi1iIl"""'''''''''''''''' <br /> <br />..- <br /> <br />_iWliW"'" ..~ ~t <br /> <br />:mi'W~3:~~~~iiif'i~'W~itSr~~l!~~i <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br /> <br />D Fumigation Tent <br />o Hazardous Material (Tier II or RQ Facility) ANNUAL <br />D Hood Installation <br />D LP/Natural Gas-Installation <br />D <br />D Places of Assembly-AN <br />o Recreational Bum <br />D Sparklers <br />D Sprinkler System Installations <br />D Standpipes (Sprinkler Sys) <br />D Torch Roofing <br />D Waste Tire Storage ANNUAL <br /> <br />D <br />D <br />o <br />o <br />D <br />~ <br /> <br />o <br />o <br />o <br />o <br />o <br />D <br /> <br />Comm Exhaust Kitchen Hood/Duct <br /> <br />Controlled Bum <br /> <br /> <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />Sprinkler D <br />Fire Alann ~ <br />Hood Clean/Suppression D <br />Fire Alann Installation <br />Fire Pumps <br /> <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />Valuation of Project <br /> <br />Other: <br /> <br />- <br /> <br />_~.&.d <br /> <br />......~~ <br /> <br />I ?fj~~t\\:: ~~~Cf1 ;t~ y~<) <br /> <br />",~~... .....,~;~ <br /> <br />J~~ <br /> <br />.b.~~' <br /> <br />~~~r'~"':;~"~~1 <br /> <br />~.rf; <br /> <br />~~~:~:~r I J('Lul~ <br /> <br />Add~": :,1L11C) l'Jea.<UurL ::P\Ci"LQ. <br /> <br />ELECTRICIAN <br />Signature <br /> <br />Address I <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br />Signature <br /> <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />Company <br />Registered <br /> <br />l:xYku h. ~ <br /> <br />License # <br /> <br />1E::f- - OOOlOL/l{; <br /> <br />I Y/N <br />I <br /> <br />I Y/N <br />I <br /> <br />I Y IN <br />I <br /> <br />I Y/N <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Company <br />Registered <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Company <br />Registered <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />'bi:~i:;7";i,.t.,...,.,.",,~,~,,~,,,--,.._.....,~.. .......""...;0~,..~..+..""'..W..1..... -~....,.~ .v." '=4.'_'.~'lilI! ~~7~"'..'"k""h'">'i"'_''''~''='~~'''''''''''''''..~_ <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. <br />