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<br />City ofZephyrhills Fir,e. <br />Permit Application <br /> <br />>,~~~:,~:;=,"~~~"~~l....~,.~:!.:~k__-,,L~~~_~<#!~~L;<;=<=r~~~~~~~~,.~,;'L"~~~,=JJ_.~~_.,.~il... <br />I II II <br /> <br />I <br />I I <br />~~1lt7;;?~r~:~~}i~~~g~~;a~~_~~~~(~~~~:~~~m:~~~~i~J~{11~qJ~rn{g;;;~~; <br /> <br />133901.0 Vo,,-Yi( ;'1119_ [ lot. I I <br />. I Parcel # I I <br /> <br />~~:~zr.;:::,~~~~ZZ"'~:qa~,Z~~~~fiW~"'$.::~''1'fii~&~~~~$;7.&3t~~~k~S:K~~T*?:~~<7!1;:~~~':&:~~%i1;;Z-~;~~~~~,d;}1W:i:::;;;,:~'~c.:Z4--<.'::::;;i~1.~~:i;i-'::- <br /> <br />813-780-0020 <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />Fee Simple Titleholder Name <br /> <br /> <br />Fee Simple Titleholder Address <br /> <br />~ F~IT,"k, <br /> <br /> <br />c==J cnher: I <br />;2tl~.\P'Z~~1~~~~B;~~~'-'''~- <br /> <br />I <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />c==J <br />c==J <br />c==J <br />c==J <br />o <br />c==J <br /> <br />Contractor <br />Signature <br /> <br />Address I <br /> <br />ELECTRICIANI <br />Signature <br /> <br />Address I <br /> <br />I <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br />Comm Exhaust Kitchen Hood/Duct <br />Controlled Bum <br /> <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />~ I~emll ~~ <br />Sprinkler 0 0 0 0 l-I <br />DooOc=J <br />El 0 er'" 0 c=J <br />B 0 c.-/ 0 c=J <br /> <br />Fire Alarm <br /> <br />Hood Cleaning <br /> <br />Hood Suppression <br /> <br />Fire Alarm Installation <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />11 <br /> <br />fJ63( <br /> <br />Fax-813-780.0021 <br /> <br />"":",,,~.,,:c;,:..;.;."'~4>... <br /> <br />Owner's Phone Number <br /> <br />Titleholder Phone Number I <br /> <br />II <br /> <br />II <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 <br />Places of Assembly-ANNUAL <br /> <br />Recreationai Bum <br /> <br />Sparklers <br />Sprinkler System Installations <br />Standpipes (Sprinkler Sys) <br />Torch RoofingfTar Kettle <br />Waste Tire Storage ANNUAL <br /> <br />Valuation of Project <br /> <br />I <br />......-.!N'~.i'.:::m:~:!llr""'~~~~,,~-""""""""',~, <br /> <br /> <br />I ~:;::d I Y I N I Fee Current Y I N I <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br />I License # I <br /> <br />L Compo" 1,4 UJA(~ r:f~ <br />---, .~~?;~;:~~ <br /> <br />License # <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br />Signature <br /> <br />Address I <br /> <br /> <br />OTHER ~ .-, <br />Signature /c::- / /<--t:.L<~!./L--.. <br /> <br />~-'~~'\1S&:;.L~: <br /> <br />Directions: <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 />Suppiy two (2) sets of drawings with applicable documentation <br />Allow 10.14 days for review after submittal date. <br /> <br />Company <br />Registered <br /> <br />Y IN I <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />Y/N I <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />Y/N I <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Parcel # - obtained from Property Tax Notice (http://appraiser.pascogov.com) <br />