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<br />813-780-0020 <br /> <br />1+ 9/0D1 <br /> <br />Fax-813-780-0021 <br /> <br />City of Zephyr hills Fife <br />Permit Application <br /> <br />... <br /> <br /> <br />'i~~~:=~_2~J<"",*"w",,,,,,,,,,,,-,,,-'-"_'~ <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />p=e ~~n~~~~~~Ll'B_1LZl&-?~LZ:CZ,,11 <br />"l.f/3 117.f3 I r1S-? cfl <br />Fr 335 l/.::L. <br />II <br /> <br />Owner's Phone Number <br /> <br />I (}14.TeS TJ e ()r)Jr'<1 K~I 1-{ e SOl" / <br />3 '1<--51 ki-LY'e-L V~/t' 13L~tl <br /> <br />Fee Simple Titleholder Name <br />Fee Simple Titleholder Addres~ I <br /> <br />Job Address ~~e---~ <br /> <br />Sub Division <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 <br />Signature <br />Address I <br /> <br />MECHANICAL1 <br />Signature <br /> <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />.4 Addres~..I. <br />Directions: <br /> <br /> Company \ <br /> Registered Y/N <br /> License # I <br /> I Company I <br /> Registered Y/N <br /> I License # I <br /> I Company I <br /> Registered Y/N <br /> I License # I <br /> I Company I <br /> Registered Y/N <br /> I License # I <br /> I Company I <br /> Registered Y/N <br /> , I License # J _=.~.. <br />~. "",,,,,~-*-\y,.,.,- <br /> <br />~~ ~-~~ <br /> <br />~,=_ __..""J <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 />Fire Alarm 0 0 0 0 r==J <br />Hood Cleaning 0 0 0 0 r==J <br />Hood Suppression 0 0 0 0 r==J <br />Fire Alarm Installation <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br />Fuel Tanks <br /> <br /> <br />.;{ '. "--="'^,,",''''''''''''<.i<J:;' ""-'lIlMQ_~",iliii;.~1:ff'~';'''''''' <br /> <br /> <br />II <br /> <br />Titleholder Phone Number I <br /> <br /> <br />"""~__ """_;Wll~~ <br /> <br />~- <br />I Lot# <br /> <br />'1 <br /> <br />Parcel # <br /> <br />D Fumigation Tent <br />D Hazardous Material (Tier II or RQ Facility) ANNUAL <br />D Hood Installation <br />D LP/N~tural Gas-Installation <br />D LP/Natural Gas-ANNUAL Sale <br />N 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 Roofingrrar Kettle <br />D Waste Tire Storage ANNUAL <br /> <br />Valuation of Project <br /> <br />ill <br /> <br />.~ ~l_'W . <br /> <br />mH <br /> <br />~uw! <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 />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />'T..d,' _. """ .~<,..__,..~J <br /> <br />1 ~. <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 />