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<br />City of Zephyr hills 'Fir.-e' <br />Permit Application <br /> <br />Date Received' ., ,. J F / ~b ~ Ie.. ' , . . ,"' . P~~"ne Contact for Pe,rmit. J .,. I I [I I <br />"':~:'::;iWlt~&HK:~:?:1~~~~~~!iMH~j'$tK~W;~W:g{~..";".;",:~,,,>""'~""":":"f~''''''''''''~''::~A'''~_'''''')i;'~'''':,,,,^,;';~'''''';~\<.~~~-''''Di}..~.ti.l~~~~_:f,:~ig~::~;,~)i;'w:\""""~~.~"..,.;<<>~2!b'"""""""~:;,,,,,~.j";;;:<:",,,,,~mr"'.':':~":~N;';~'~''''''''~'>i';'''''+''~ <br /> <br />'I II I ,I I <br /> <br /> <br />813-780-0020 <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />Fee Simple Titleholder Name <br />Fee Simple Titleholder Address <br /> <br />Fax-813-780-0021 <br /> <br />Titleholder Phone Number <br /> <br />II <br /> <br />II <br /> <br />Job Address I <br /> <br />Sub Division I <br />g:~'11i~aH%~~~'t~Zi&.~~~~W'~- <br /> <br />D <br />D <br />D <br />D <br />~ <br /> <br />D <br /> <br />~ <br /> <br />D <br />W&_~Nf;;n~~~~at.:~ <br /> <br />Contractor <br />Signature <br />Address <br /> <br />ELECTRICIAN <br /> <br />Signature <br /> <br />Address I <br /> <br />PLUMBER <br /> <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br /> <br />Signature <br /> <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />;~~".,~ <br /> <br />!\~~m~~~\ <br /> <br />& <br /> <br />\~I~~ ~ <br /> <br />I Lot#1 <br /> <br />Parcel # <br />"."",..,;11I"" <br /> <br />D Fumigation Tent <br />D Hazardous Material (Tier II or RQ Facility) ANNUAL <br />o Hood Installation <br />o LP/Natural Gas-Installation <br />o LP/Natural Gas-ANNUAL Sale <br />D Places of Assembly-ANNUAL <br /> <br />D Recreational Bum <br />D Sparklers <br />D Sprinkler System Installations <br />D Standpipes (Sprinkler Sys) <br />o Torch Roofingrrar Kettle <br />o 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 />0~'~;"~D <br />Do 0 oc=J <br />Doooc=J <br />Do ooc=J <br /> <br />Sprinkler <br /> <br />Fire Alarm <br /> <br />Hood Cleaning <br /> <br />Hood Suppression <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 />I <br />_~~~_.,_",_d<Wt; <br /> <br />Company I I <br />Registered Y I N Fee Current Y I N <br /> <br />License # I <br /> <br />Company I <br />Registered Y I N <br /> <br />License # I <br /> <br /> <br />I Y/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 <br /> <br />Fee Current <br /> <br />Y/N <br /> <br /> <br />Company <br />Registered <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Address <br /> <br />License # <br /> <br />Directions: <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 />