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<br />81:3-:780-0020 <br /> <br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />Fee Simple Titleholder Name <br /> <br /> <br />City of Zephyrhills -Fire' <br />Permit Application <br /> <br />Fax-B13-780-0021 <br /> <br />Phorie Contact for Permit <br /> <br /> <br /> <br />Owner's Phone Number I <br />J'Jrt-/O <br /> <br />Titleholder Phone Number I <br /> <br />II II I <br />I <br />Lot:-l1~~1 <br />I <br /> <br />'2- <br /> <br />Fee Simple Titleholder Address I <br /> <br />:'FAddress I ~ r vc~ <br />I <br /> <br />Sub Division <br /> <br />~mlr# <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />Contractor <br /> <br />Signature <br /> <br />Address <br /> <br />ELECTRICIANl <br />Signature <br /> <br />Address I <br /> <br />I <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br />Signature <br /> <br />Address I <br /> <br />OTHER <br /> <br />Signature <br /> <br />_""" Address J_,,," <br />Directions: <br /> <br />Bic-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 ~ l!l 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 Applicatlon- ANNUAL <br /> <br />Fuel Tanks <br /> <br /> <br />,.'....~v,,""""""'')_~,.~. ,', ~, :mil "-r'\iIii:~l'f'i"C <br /> <br />v.=- ',' _,~~.,.~~.",-",~ <br /> <br />n " _. >~..,,-J <br /> <br />II II <br /> <br />Bill; <br /> <br />Parcel # <br /> <br />" ~~e <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 />I <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 />CJji <{ 51 iJ <br /> <br />Recreational Bum <br /> <br />Sparklers <br />Sprinkler System Installations <br />Standpipes (Sprinkler Sys) <br />Torch RoofinglTar Kettle <br />Waste Tire Storage ANNUAL <br /> <br />Valuation of Project <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />~ hY~ ~O h~1 :f;Vc;, <br />r7YJii\Jl Fee Current I Y I N I <br />[ITlo m 'b'ZfJ(1) 11 Cfl1 q <br /> <br />I Y 1 N I Fee Current <br />I <br /> <br />I Y 1 N <br />I <br /> <br />1 Y I N I Fee Current <br />I <br /> <br />I Y/N <br />I, <br /> <br />Company <br />Registered <br /> <br />Y/N <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Company <br />Registered <br /> <br />Y/N <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />. "'-~'''='*,'-'._.''''m"~_n!il!!l!l!llll!l <br /> <br />,'[' <br /> <br />"'t""'"" <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://appralser.pascogov.com) <br />