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<br />813-780-0020 <br /> <br />City of Zephyr hills Fir,s, <br />Permit Application <br /> <br />Fax-813-780-0021 <br /> <br /> <br />Date Received <br /> <br /> <br />. Pho~e Contact for Permit <br /> <br />Owner's Name I Wt:t/ /'f~b"r .:#Ji,J17t:7~ <br /> <br />OWner's Address ~ ~// DIe/a!' <br /> <br />F.. 81m", "'"""", ""me I .- <br />Fee Simple Titleholder Address I <br /> <br />li/3 <br /> <br />117~ /0//YS-7/ <br />I <br />II II I <br />I <br />i Lot# 01 -, <br />I <br /> <br />Owner's Phone Number <br /> <br />I Titleholder Phone Number I <br /> <br />Job Address <br /> <br />Sub Division <br />Ull <br /> <br />Parcel # <br /> <br />D <br />D <br />D <br />D <br />D <br />~ <br /> <br />Bio.Hazaro"Waste Storage - ANNUAL <br />Comm Exhaust Kitchen Hood/Duct <br />Controlled Bum <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 /"/~' C; <br />Places of Assembly-ANNUAL /0/ 1 () t I <br /> <br />Recreational Bum (')I ~ <br /> <br />Sparklers <:.----' . <br /> <br />Sprinkler System Installatlo ._~_' <br /> <br />Standpipes (Sprinkler Sys) -~.r( ~ 0 h <br /> <br />Torch RoofinglTar Kettle #)(L. <br />Waste Tire Storage ANNUAL <br /> <br />Emergency Generator < 30 kw <br /> <br />Emergency Generator> 30 kw ~"'.o- <br />Fire Protection Maintenance - ANNU ' , <br />em." n ~ <br />SPrinklerD DOL--' <br /> <br />Doooc=J <br /> <br />Do ooc=J <br /> <br />~o ~oc=J <br />.~S:IS-tJ~ <br />r,fYl <br /> <br /> <br />Fire Alarm <br /> <br />Hood Cleaning <br /> <br />Hood Suppression <br /> <br />~ <br /> <br />D <br /> <br />Fire Alarm Installation <br /> <br />Fire Pumps <br />Fire Works <br />Flammable Appllcatlon- ANNUAL <br /> <br />, <br /> <br />Valuation of Project <br /> <br />Fuel Tanks <br />Other: <br />, I /]Z"e- gtl<v r~e- <br /> Company <br />~ Registered <br /> fl) N Fee Currer{ I Y I N I <br /> License # I <br /> Company <br /> R.eglstered Y/N Fee Current Y/N I <br /> License # I <br /> Company <br /> Registered Y/N Fee Current Y/N <br /> License # I <br /> Company I <br /> Registered Y/N , Fee Current Y/N <br /> License # I <br /> Company I , <br /> Registered Y/N I Fee Current Y/N <br /> License # <br /> <br />Contractor <br />Signature <br /> <br />Address <br /> <br /> <br />ELECTRICIAN <br />Signature <br /> <br />Address I <br /> <br />PLUMBER I <br /> <br />Signature <br />Address I <br />MECHANICALI <br />Signature <br />. Address I <br /> <br />OTHER <br />Signature <br /> <br />Address I <br /> <br />Directions: <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 />