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<br />813-780-0020 <br /> <br />City of Zephyr hills Fir.-s' Fax-813-780-0021 <br />Permit Application <br /> <br />,-, m~~~.:~~~_tM__-LLM"~,~,.,,,l.L"'~'M,,.___1 <br />"] II 1.1 <br /> <br /> <br />Fee Simple Titleholder Name <br /> <br />Fee Simple Titleholder Addressj <br />WWf~~~Mll&!l~}JJIlIi:ml~'-' <br /> <br />Job Address I <br /> <br />Sub Division ~ <br />H_.M%~~~' ...' "", .. _...,i'V-' <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />D <br /> <br />D Fire Pumps <br />B Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />D other: I <br />~tf'!I!lil\I~"""l: <br /> <br />I <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />Contractor <br /> <br />Signature <br /> <br />Address I <br /> <br />ELECT, RICIANI <br />Signature <br /> <br />Address I <br /> <br />--'Vt7' <br /> <br />i5il <br /> <br />J <br /> <br />. :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 /> <br />Torch RoofingfTar Kettle <br />Waste Tire Storage ANNUAL <br /> <br />Valuation of Project <br /> <br />Bic-Hazard Waste Storage -ANNUAL <br /> <br />Comm Exhaust Kitchen Hood/Duct <br /> <br />Controlled Bum <br /> <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />~~~~ <br />Sprinkler D 0 0 0 L--J <br />Do ooc=J <br />~o ~o c=J <br />~o [3 oc=J <br /> <br />Fire Alarm <br /> <br />Hood Cleaning <br /> <br />Hood Suppression <br /> <br />Fire Alarm Installation <br /> <br />:'liill!l!l <br /> <br />MI <br /> <br />_~~, <to ~~~~~~v~.... <br /> <br />I <br />lMrlU'~f~S: <br /> <br />I <br /> <br />"-",.....",~~~""-"-'=.,. J <br /> <br />Company <br /> <br />Registered <br /> <br />License # <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br />Signature <br /> <br />Address I <br /> <br />OTHER I '~ <br />Signature _~~ -::::::>~ <br /> <br />___~=,::.~~~,...~~:; ,.2~J2 <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 />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Company <br />Registered <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />License # <br /> <br />~:;:~:d I ~1N~et~ I Y/N I <br />~n~~ :II!~ .J;?,,~~~::;-.~~,.~,::~,~L.,_,~.~_Lt <br /> <br />r .~;lljt; <br /> <br />RII 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 Properly Tax Notice (http://appraiser.pascogov.com) <br />