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<br />813-780-0020 <br /> <br />Date Received <br /> <br />. /:<::::;:::-:".:::~f.'E;::;, <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />City of Zephyrhills Fir-e <br />Permit Application <br /> <br />._)J LJ I <br />X't ?,. II tq 07 I LW7 (., I <br />I <br />I <br />I <br />I <br />I <br /> <br />J <br />I. (~PPJ <br />. ?~2~ <br />I <br />I <br /> <br />...... ". ..... .Jw:~",:;,?::~:'",cc;;"",:".,,:r:"c:',,:,, <':J>.;:;;.:;:r; <br /> <br /> <br />~6t <br />__LL. 7LLlO <br /> <br />Fee Simple Titleholder Name <br /> <br />Fee Simple Titleholder Address <br /> <br />":';:;-;;:;.~:; <br /> <br />~a:~::u~,~:;~;;~;;:~;::{~~: ':; __ ^ <br /> <br />Fax-813-780-0021 <br /> <br />,..,J..... <br />I <br /> <br />Phone Contact for Permit <br /> <br />'~:'~:;.:.:2?,;::;::;::::;.':-:::';~~::p:?:.:::; <br /> <br />,,';~,.,.,:' <br /> <br />Owner's Phone Number <br /> <br />I Titleholder Phone Number I <br /> <br />II <br /> <br />II <br /> <br />~ ....(... ">.i"::~~;,.~:. 't'" /<;:; ;.,,~ -<''":'''. : y _-:-"'~ ~ :;:'[;?''f;:.:if.t:~rf?:;71?,~~;7f,_:~if]jf:?~,1:~~\.ri2i.:::~~'i}t;':.?:I;~1t':f?:tt:::~!:i~;)>~ "':;;2i"/;:ST'!J:;:>4}::.:r:;:,;t-t:'i~~{'J~>:'.-:<T,:_,::;r?r~?~~~;;;;;~::;;;t13;Jl<~:;'_:i{??~;:~' <br /> <br />I <br />I <br /> <br />..' -- -. :;"";':'f:~f:I:dT~'1r:;'1:;:'):;':Di~;~~.:{~:J;::;:~?~q;;;:;:":.L~V;i/.;;',f(i:;"S<<:'.}::f.'<i.;;';;,:t-0~~iii.~~ct"&;.;;:.~~J};i:.~1;x;;~<r50~:':i;:;?:1:;;J:J0.i~r;.:~;~~}.x;t,,~:;,i, l~';::U;S;i,\~;Q'X~;:r;';::E:~:~:,7_~;Z'~i.:'i;$'$$~X~J.-:;~'. ~"';"" ,~;:::::-~~'_:,';;';:;,;,~::.:':1~<y~--;:_';:.:'n', <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />Contractor <br />Signature <br /> <br />Address I <br /> <br />ELECTRICIANI <br /> <br />Signature . <br /> <br />Address I <br /> <br />PLUMBER I <br /> <br />Signature <br />Address I <br />MECHANICALI <br />Signature <br /> <br />n'."'",.._. . <br /> <br />r'-~~:#- .' <br /> <br />:,'::::~:::~,:,',(,::;;;'::;2-: <br /> <br />D <br />D <br />D <br />D <br />D <br />D <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 /> <br />Do 0 dc=] <br /> <br />[kJo ~oc=] <br /> <br />G'" 0 ~ 0 c=J <br /> <br />Parcel # <br /> <br />D Fire Alarm Installation <br /> <br />D <br /> <br /> <br />EI '"" TO','" <br />D Other: I <br />;:':2rrC:'2Z'';;lif2g1::}';;j~~~;~::Jk'2~~~~~Ufif~'t:,L'E+iit'~~~2~~f:1',t1llif"4iSt~1;~~t.;~:f8r@'i~4'f'.&2?-i:,.m.y.Jt.~jiW;r.4'::E:.$~8~';..tZu.;;;2~L!:;i;;Z;if~~3&2-;';}~2:t_E':.lijt~iLil:~:~1:,:2i:.~TIili2:-;~ez:2';i~'~:;;z:;:,t'{;2:::'i~~'2.,:~:~,-;;~':LK~::~jL,;~r:D.r::'tbilJ~,:'f;);~<~~;::~S;~ <br />I <br /> <br />Fire Alarm <br /> <br />Hood Cleaning <br /> <br />Hood Suppression <br /> <br />Fire Pumps <br /> <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />-:,e?~:r_:) , <br /> <br />'~,-" ,,;':0.;', <br /> <br />D <br />D <br />D <br />'0 <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />o <br /> <br />Fumigation Tent <br />Hazardous Material (Tier" 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 />Recreational Bum <br /> <br />Sparklers <br />Sprinkler System Installations <br />Standpipes (Sprinkler Sys) <br /> <br />Torch RoofingfTar Kettle <br />Waste Tire Storage ANNUAL <br /> <br />Valuation of Project <br /> <br />Company I <br />Registered Y I N <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 I Fee Current <br /> <br />License # I <br /> <br />Company I <br />Registered Y I N <br /> <br />Address I I License # I I <br /> <br /> <br />~:;=~~~~o~;;:;;~~~_~~___.~J~;:~.l1{;~~1~;1J~' N_L.,=~= <br /> <br />Directions: . --- - . <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <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 />