Laserfiche WebLink
<br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />813-780-0020 <br /> <br />J f3lf<f <br /> <br /> <br />Phone Contact for Permit <br /> <br />City of Zephyrhills 'Fir-e <br />Permit Application <br /> <br /> <br />.:J"U L <br />Ie 4UNf1l- 'f I~ I ~ ~ "I-J <br />js-; z.. r ~ "t...L f)r-VO, <br />I t.1C.K <br />I <br />5"3 2- -, <br /> <br />JD/ <br /> <br />Fee Simple Titleholder Name <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />Fax-813-780-0021 <br /> <br /> <br />II? ,., 111~Ya1 <br />I <br />I <br />I <br />I <br /> <br />Owner's Phone Number <br /> <br />1"/3 <br /> <br />I Titleholder Phone Number I <br /> <br />II <br /> <br />II <br /> <br />I Lot# <br /> <br />D <br />D <br />D <br />D <br />D <br />D <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 />[9!!!Y] ~ ~ ~ <br />Sprinkler 0 0 0 0 L.J <br /> <br />Fire Alarm 0 0 0 0 c=J <br /> <br />Hood Cleaning [0" r/ 0 0 c=J <br /> <br />Hood Suppression 0 0 0 0 c=J <br /> <br />Fire Alarm Installation <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br />Other: <br /> <br />Parcel # <br /> <br />D <br />D <br />B <br />D <br />D <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 />Recreational Bum <br /> <br />Sparklers <br />Sprinkler System Installations <br /> <br />$~ <br /> <br />Standpipes (Sprinkler Sys) <br /> <br />Torch RoofingfTar Kettle <br />Waste Tire Storage ANNUAL <br /> <br />Valuation of Project <br /> <br /> <br />Company I .6.Jl-IF!U.eT C. u 17t!!i!J <br />Registered Cf)1 N I Fee Current I t:f) N <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Contractor <br />Signature <br /> <br />Address I iff,!} '}- DL/,t."""/rl.,1- ,t/J. <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 />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 />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 />