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<br />813-780-0020 <br /> <br />Date Received <br />;i!iii <br /> <br />OWner's Name <br /> <br />OWner's Address <br /> <br />Fee Simple Titleholder Name <br /> <br />Sub Division <br /> <br />~~ ,:!I,T l>l <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />Contractor <br />Signature <br /> <br />Address <br /> <br />ELECTRICIAN <br />Signature <br /> <br />Address I <br /> <br />PLUMBER I <br /> <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br />Signature <br /> <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />_ Address L~,,~ <br /> <br />Directions: <br /> <br />Fax-813-780-0021 <br /> <br />City of Zephyr hills Firoe <br />Permit Application <br /> <br />~;;:i;;d~#<"~ <br /> <br /> <br />I <br />-~; <br /> <br /> <br />! <br />I <br />I <br />liT I "~T!!llng!ll '''''1 <br /> <br /> <br />I <br /> <br />Phorie Contact for Permit <br /> <br />I <br />II <br />III <br /> <br />Fee Simple Titleholder Addres~ <br />~A f flit rn~~ ~lwm <br /> <br />Job Address _ <br /> <br />I <br /> <br />~~~~E,C~~ <br />7 0 ~ LL. "0 <br />I <br />I <br /> <br />. Wl'{- <br /> <br />II rlUllll1- <br /> <br />Owner's Phone Number <br /> <br />II <br /> <br />- <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 0 0 0 0 ~ <br />Fire Alarm 0 0 0 0 c=I <br />Hood Cleaning ~ ~ 0 0 c=I <br />Hood Suppression 0 0 0 0 c=I <br />Fire Alarm Installation <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br />Fuel Tanks <br /> <br /> <br />{' ,'.'; - ~^'.-y <br /> <br />I Titleholder Phone Number <br /> <br />II <br /> <br />lllWUIliIl!!!"'JIlIl ~ <br /> <br />tl <br /> <br />I.I! <br /> <br />t~ IIm:w U~ <br /> <br />I <br /> <br />Lot # <br /> <br />Parcel # <br /> <br />I <br /> <br />II: ' -~1IIIIII.7-' ....--M:~lliimll!1?- "'1!r'_illlil ;'" <br /> <br />D Fumigation Tent <br />D Hazardous Material (Tier \I or RQ Facility) ANNUAL <br />D Hood Installation <br />D LP/Natural Gas-Installation <br />D LP/Natural Gas-ANNUAL Sale <br />D 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 RoofinglTar Kettle <br />D Waste Tire Storage ANNUAL <br /> <br />Valuation of Project <br /> <br /> Company I <br /> Registered <br /> License # I <br /> Company I <br /> Registered <br />I License # I <br />I Company I <br />Registered <br />I License # I <br />I Company I <br />Registered <br />I License # I <br />I Company I <br />Registered <br />J License # J <br /> <br />N'5A <br />Y/N I <br /> <br />SEe", Lr,,> I NC <br />Fee Current L Y I N J <br />I <br /> <br />Fee Current Y I N I <br />I <br /> <br />Y/N <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 IN I <br /> <br /> <br />. ., -."...". ,-~.J <br /> <br />1'1, <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />,...w',..-."'"""_.......""".._""=~_. ~o~ <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 />