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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 Fil'e' <br />Permit Application <br /> <br /> <br />w It /--~ fV\/t K\ <br />7 (0 <. ~ G Ift-'- <br />I <br />I <br /> <br />Bou\c\JD.,J'~ <br /> <br />I Titleholder Phone Number I <br /> <br />II <br /> <br />II <br /> <br />Fee Simple Titleholder Name <br /> <br />Fax-813-78o-oo21 <br /> <br />Phone Contact for Pennit <br /> <br /> <br />Owner's Phone Number <br /> <br />II <br /> <br />II <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />7 6 ~ I Sa.. I f B I vJ <br /> <br />Parcel # <br /> <br />I Lot# <br /> <br />I <br /> <br />Contractor <br />Signature <br /> <br />Address <br />ELECTRICIANI <br />Signature , <br />Address I <br />PLUMBER <br />Signature <br />Address I <br />MECHANICALI <br />Signature <br />Address I <br />OTHER <br />Signature <br />Address <br />Directions: <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 < 3D kw <br />Emergency Generator> 3D kw <br />Fire Protection Maintenance - ANNUAL <br />~~~~ <br />Sprinkler 0 0 0 0 L-J <br /> <br />Fire Alann 0 0 0 0 c=I <br /> <br />Hood Cleaning W 0 _ 0 c=I <br /> <br />Hood Suppression 0 0 0 0 c=I <br /> <br />Fire Alann 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 />~ <br /> <br /> <br />o <br /> <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 />Hood Installation <br />LP/Natural Gas-Installation <br />LP/Natural Gas-ANNUAL Sale <br />Places of Assembly-ANNUA <br /> <br />Recreational Bum <br /> <br /> <br />Sparklers <br />Sprinkler System Installations <br />Standpipes (Sprinkler Sys) <br />Torch Roofing/Tar Kettle <br />Waste Tire Storage ANNUAL <br /> <br />Valuation of Project <br /> <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 />Company <br />Registered <br /> <br />License # <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 />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 completeiy, <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 />