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<br />813-780-0020 <br /> <br />City of Zephyrhills 'Fife <br />Permit Application <br /> <br />.. .. <br />Date Received <br /> <br /> <br />Owner's Name <br /> <br />149a- ,4~~~l.&:O <br /> <br />Owner's Address <br /> <br />Fee Simple Titleholder Name <br />Fee Simple Titleholder Address <br /> <br />Fax-813-780-0021 <br /> <br />Phone Contact for Permit <br /> <br /> <br />II <br /> <br />Owner's Phone Number <br /> <br />II <br /> <br />I Titleholder Phone Number I <br /> <br />II <br /> <br />II <br /> <br />Job Address <br /> <br />Co 2/1 t4~ rr 57/11],11/ <br /> <br />101 <br /> <br />Lot # <br /> <br />Sub Division <br /> <br />Parcel # <br /> <br />D <br />D <br />D <br />D <br />D <br />D <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 />D <br />D <br />D <br />D <br />D <br />D <br />I <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 B" 0 ~ 0 c::J <br /> <br />Fire Alarm Installation <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br />Other: <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 RoofingfTar Kettle <br />Waste Tire Storage ANNUAL <br /> <br />Valuation of Project <br /> <br />Contractor <br />Signature <br /> <br />Address I <br /> <br />ELECTRICIANI <br /> <br />Signature <br /> <br />Address I <br /> <br />PLUMBER <br /> <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br /> <br />Signature <br /> <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />Address <br />m_ <br />Directions: <br /> <br /> <br />Company <br /> <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Company <br /> <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Company <br />Registered <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />Y I N I <br /> <br />I <br /> <br />Company CS't:"".JQ.~ .J--/F"-:: ~,p <br />Registered I Y I N I Fee Current I I N I <br /> <br /> <br />~""""""~"@_",."",,,,_"_,,,_,,'"~~,*'~_!i <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />License # <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 />