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<br />813-780-0020 <br /> <br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />City of Zephyrhills Fir;e <br />Permit Application <br /> <br />Fax-813-780-0021 <br /> <br /> <br />Fee Simple Titleholder Name <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br />i\~~WilllJjiro <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />~~!il , <br /> <br />Contractor <br />Signature <br /> <br />Address I <br /> <br />ELECTRICIANI <br /> <br />Signature <br /> <br />Address I <br /> <br />PLUMBER <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 />Z 6-1' "=Di/ L L3 <br /> <br />I pa_~#l!l!!!:1 . 11_ ,_ <br /> <br />o <br />D <br />D Hood Installation <br />D <br />o <br />o Places of Assembly-ANNUAL <br /> <br />o Recreational Bum <br />o Sparklers <br />o Sprinkler System Installations <br />o Standpipes (Sprinkler Sys) <br />D <br />o <br /> <br />I <br />f3.tG,S~ ~~ N E <br /> <br />~ 1 <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 />~~~~ <br />Sprinkler D 0 DOL--' <br />Doooc=J <br />Doooc=J <br />B'o ~oc:=J <br /> <br />Fire Alarm <br /> <br />Hood Cleaning <br /> <br />Hood Suppression <br /> <br />D <br /> <br />~ <br />D <br />I <br /> <br />Fire Alarm Installation <br /> <br />Fire Pumps <br /> <br />Fire Works <br /> <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />Other: <br /> <br />Phone Contact for Permit <br /> <br /> <br />Owner's Phone Number <br /> <br />Titleholder Phone Number I <br /> <br />II <br /> <br />II <br /> <br />I <br />I <br />ll~~ ~~l <br /> <br />I <br />I <br /> <br />JI!!Il:IIII!:II': <br /> <br />~ <br /> <br />'_m.~'" <br /> <br />I <br /> <br />m:w' <br /> <br />~ ~l# <br /> <br /> <br />i:;m ~t~~~ <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 /> <br />Torch RoofingfTar Kettle <br />Waste Tire Storage ANNUAL <br /> <br />Valuation of Project <br /> <br /> <br />~~ <br /> <br />Company <br />Registered <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Company <br /> <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Company <br />Registered <br /> <br />License # <br /> <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 />