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<br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />~1I~ <br /> <br />813>< 780-002C1 <br /> <br />City of Zephyrhills Fir-s' <br />Permit Application <br /> <br /> <br />o S <br /> <br />Fax-813-780-0021 <br /> <br />Phorie Contact for Permit <br /> <br /> <br />Owner's Phone Number <br /> <br />1'1 )3 <br /> <br />II 7<6 1< III \ \ '-f I <br />I <br />II II I <br />I <br />I Lot# I <br />I <br /> <br />Fee Simple Titleholder Name <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />-;<6l-?.D <br /> <br />t+t t-J a..y D /L- <br /> <br />I Titleholder Phone Number I <br /> <br />Parcel # <br /> <br />Contractor <br />Signature <br /> <br />Address I <br /> <br />ELECTRICIANI <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 />o <br />o <br />o <br />o <br />o <br />o <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 D 0 0 0 ~ <br />Fire Alarm D 0 0 0 c=J <br />Hood Cleaning D 0 0 0 c=J <br />Hood Suppression 0 0 !iK. 0 c=J <br /> <br />o Fire Alarm Installation <br /> <br /> <br />B <br /> <br />o Fuel Tanks <br />o Other: <br /> <br /> <br />I l~ \ <br /> <br />Fire Pumps <br /> <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />o <br />o <br />o <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 />Recreational Bum <br /> <br />Sparklers <br />Sprinkler System Installations <br />Standpipes (Sprinkler Sys) <br />Torch Roofingrrar Kettle <br />Waste Tire Storage ANNUAL <br /> <br />Valuation of Project <br /> <br />Ir~ f, <br />I <br /> <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br />Company I 61/~fU:vf-#1'f HK:t: !:... <br />Registered Y I N I Fee Current I <br /> <br />License # <br /> <br />5 f c..u .c. \ "''1 <br />Y IN I <br />I <br /> <br />Y IN I <br />I <br /> <br />Company <br />Registered <br /> <br />License # <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 />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 />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 />