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<br />813-780-0020 <br /> <br />.. <br /> <br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />Jf15q ( <br /> <br />Fax-813-780-0021 <br /> <br />City of ZephyrhillsFire <br />Permit Application <br /> <br />Fee Simple Titleholder Name C- <br />Fee Simple Titleholder Address <br /> <br />~~) <br /> <br /> <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />o <br />o <br />o <br />o <br />o <br />o <br /> <br />Contractor <br />Signature <br />Address <br /> <br />ELECTRICIANI <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 <br />Directions: <br /> <br />t /JJ17fij{) <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 L-J <br />Fire Alarm 0 0 0 0 C=:J <br />Hood Cleaning 0 0 0 0 C=:J <br />Hood Suppression 0 0 0 0 C=:J <br />Fire Alarm Installation <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br />Fuel Tanks <br />Other: <br /> <br />II <br /> <br />II <br /> <br />Parcel # <br /> <br />liilnm.~1n' <br /> <br />I Lot# I <br />-L!J- ~-lI-oDlo...o(,(poo- CX>ll <br /> <br />dam; <br /> <br />D Fumigation Tent <br />D Hazardous Material (Tier II or RQ Facility) ANNUAL <br />D Hood Installation <br />D LP/Natural Gas-Installation <br />D LP/Natural Gas-ANNUAL Sale <br />~Iaces of Assembly-ANNUAL <br /> <br />o Recreational Bum <br />o Sparklers <br />o Sprinkler System Installations <br />o Standpipes (Sprinkler Sys) <br />D Torch RoofinglTar Kettle <br />D Waste Tire Storage ANNUAL <br /> <br />Valuation of Project <br /> <br />,~' -remMl,!@!' - <br /> <br />Company rFrP2i r(J'Y)~ <br />Registered ~ Fee Current <br /> <br />License # I <br /> <br />Company 1 <br />Registered Y I N <br /> <br />License # I <br /> <br />Company I <br />Registered Y I N I Fee Current <br /> <br />License # I <br /> <br />Company I <br />Registered Y I N <br /> <br />License # I <br /> <br />Company I <br />Registered Y I N <br /> <br />~!).llm ~'<<;lIj~~ ~_i <br /> <br />----r7UT ({ J <br />1---vTN'l - <br />I <br /> <br />Y I N I <br />I <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <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 />