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<br />813-780-0020
<br />
<br />City of Zephyrhills Fir.e
<br />Permit Application
<br />
<br />#11 q ';
<br />
<br />Fax-813-780-0021
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<br />
<br />
<br />&> Owner's Name
<br />
<br />o Owner's Address
<br />
<br />I
<br />J27'7/;- ..e.l/t>n/ &.../ ~"~t
<br />
<br />Fee Simple Titieholder Address
<br />
<br />4J Job Address
<br />
<br />Sub Division
<br />
<br /> II II
<br /> ? 3 r- z.
<br />Titieholder Phone Number II II
<br />F- '3 f Jy L I Lot#
<br />Parcel # I
<br />
<br />D
<br />B
<br />B
<br />D
<br />
<br />4. Contractor !
<br />.:...-/'Slgnature .
<br />
<br />Address
<br />
<br />ELECTRICIANI
<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 />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 < 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 0 0 0 0 c=J
<br />
<br />Hood Suppression 0 0 0 0 c=J
<br />
<br />Fire Alarm Installation
<br />
<br />Fire Pumps
<br />Fire Works
<br />Flammable Application- ANNUAL
<br />
<br />Fuel Tanks
<br />
<br />Other:
<br />
<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 />D Recreational Bum
<br />D Sparklers
<br />D Sprinkler System Installations
<br />D Standpipes (Sprinkler Sys)
<br />D Torch RoofingfTar Kettle
<br />D Waste Tire Storage ANNUAL
<br />
<br />Valuation of Project
<br />
<br />'Ix"? ~
<br />
<br />Va,
<br />f
<br />
<br />OTHER
<br />
<br />Signature
<br />
<br />Address
<br />
<br />Directions:
<br />
<br />~ompany
<br />Registered
<br />
<br />License #
<br />
<br />
<br />Company
<br />Registered
<br />
<br />License #
<br />
<br />Y/N
<br />
<br />Fee Current
<br />
<br />Y/N
<br />
<br />Company
<br />Registered
<br />
<br />License #
<br />
<br />Y/N
<br />
<br />Fee Current
<br />
<br />Y/N
<br />
<br />Company
<br />
<br />Registered
<br />
<br />License #
<br />
<br />Y/N
<br />
<br />Fee Current
<br />
<br />Y/N
<br />
<br />Company
<br />Registered
<br />
<br />License #
<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)
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