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<br />813-780-0020 <br /> <br />Date Received <br />~l. ~ <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />City ofZephyrhills Fjr,e. <br />Permit Application <br /> <br />II ,j:~~?1tL() ~ r <br />I <br />I <br /> <br />Ui18~ <br /> <br />tf eD~~ <br /> <br />Fax-813-780-0021 <br /> <br />Phone Contact for Pe.rmit j <br />~... <br /> <br />"I <br /> <br />~\~~__H_! ~~"U -?J.91 J <br />II /'/ I <br />I <br />I <br />I <br />.'lIlIiIlf' <br /> <br />I <br />I <br /> <br />Owner's Phone Number <br /> <br />Fee Simple Titleholder Name <br /> <br />II <br /> <br />I <br />I <br />~8aSD <br /> <br />Titleholder Phone Number <br /> <br />II <br /> <br />Fee Simple Titleholder Address <br />~ <br /> <br />Job Address <br /> <br />Sub Division <br />IUIILIL <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />Contractor <br /> <br />Signature <br /> <br />Address <br /> <br />ELECTRICIANI <br />Signature . <br /> <br />Address I <br /> <br />PLUMBER I <br /> <br />Z .(.\'Y'\,-\( ~\\ ~ \ ~ 1.- <br /> <br />1 Parcel # <br /> <br />D <br />D <br /> <br />D Hood Installation <br /> <br />D <br />D <br />D <br /> <br />D Recreational Bum <br />D Sparklers <br />D Sprinkler System Installations <br />D Standpipes (Sprinkler Sys) <br />D <br />D <br /> <br />A <br /> <br />A"t... <br /> <br />lilIZU <br /> <br />- <br /> <br />Bic-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 />. ~~~~ <br />Sprinkler 0 0 0 0 L-J <br />o 0 ]I.... 0 c=J <br />Ooooc=J <br />Doooc=J <br /> <br />Fire Alarm <br /> <br />Hood Cleaning <br /> <br />Hood SuppreSSion <br /> <br />Fire Alarm Installation <br /> <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />Other: <br /> <br /> <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br />Signature <br /> <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />Address! <br /> <br />Directions: <br /> <br />illl!:J:lI. <br /> <br />--- <br /> <br />3~SYl <br />I <br /> <br />" <br /> <br />Lot # <br /> <br />-~-'~ <br /> <br />~;r <br /> <br />liT ~_ ~i <br /> <br />Fumigation Tent <br />Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> <br />LP/Natural Gas-Installation <br />LP/Natural Gas-ANNUAL Sale <br />Places of Assembly-ANNUAL <br /> <br />Torch RoofingfTar Kettle <br />Waste Tire Storage ANNUAL <br /> <br />Valuation of Project <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br /> <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />51"""p,/~ ~ <br />Y/N I Fee Current Y/N <br /> <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Y IN I <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />L- <br /> <br />,_ d ~~~. <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 (htlp://appraiser,pascogov,com) <br />