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<br />813"-780-002'0 <br /> <br />Date Received J <br />':::i:tju;\e~@;;miWW~~:@~:M~1~g~~;;;~i;7;;~R'*t! . "',,"..,,, <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />City of Zephyr hills Fir-e Fax-813-78D-0021 <br />Permit Application <br /> <br />"","',~m';'''''M_'~_'M~"",llPm!!!l5!ll1''''i__~~~r~~~~~~~~j,","-'"."~M",~ll_""~""""""lth".N;""m,,,,,",,,,,,,1 <br /> <br />I J'lj 117J9 l,j97S-6 I <br /> <br /> <br />Fee Simple Titleholder Name <br /> <br />Fee Simple Titleholder Address i <br />Millft_{.~~~WfJ~']Jim~~w..~~~ <br /> <br />14q/?-d/1 <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />5/57 <br /> <br />6t'L(/ <br /> <br />P:4i;~~'f:&\1JPS~?:n%.~m~wn_~~~~~'1w~r ~'.~Q1l1~ I <br /> <br />o <br />o <br />EI Fo.1 Too" <br />D Other: I <br />~:~:' j ~~~. <br /> <br />Address . <br /> <br />D <br />D <br />D <br />o <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 D 0 0 0 L-I <br />Do ooc=l <br />Doooc=l <br />Doooc=l <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 />Flammabie Applicatlon- ANNUAL <br /> <br />33S-cr/ <br /> <br />Titleholder Phone Number <br /> <br />II <br /> <br />II <br /> <br />1,1~J~h'"""I'I1~~~~~~f <br /> <br />D <br />D <br />D Hood Installation <br />D LP/Natural Gas-Installation <br />D LP/Natural Gas-ANNUAL Sale <br />g-Places of Assembly-ANNUAL <br /> <br />Fumigation Tent <br />Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> <br />D <br />D <br />D <br />D <br />D <br />D <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 />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 />~.m~.=~~L <br />Directions: <br /> <br />"-""""'''-''''''''''~''''~:lW'..;:fj;'~~~'i'i~'(iii-'': < <br /> <br />" n '"'If"~'''",M@'''@''~W'''"{ j, n <br /> <br />! <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br />Company j <br />Registered <br /> <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br />,'lU/,)1t'r <br />Y I N I Fee Current <br /> <br />Y/N <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />License # <br /> <br />Company I <br /> <br />Registered <br /> <br />mli"~= # J <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />I <br />~'.i""':~"-:"--"'~~~~~"";<'__"""'_'.&"'<i>%'"~'~l <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 (htlp:llappraiser,pascogov,com) <br />