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<br />,81;;1-780-0,020 /' )._ City of Zephyr hills Fir,e, <br /> <br />';~;:$~~~~~;:~~,,_,~:.l,~,~':i,,2.:q~~ ,~~jjr;;l::~; con}:,;~~~=.M C2 <br />I L-71 S2.L 0 --f/cJ R. VAT 1-1 I Own:'sPhone Number <br />I~ jJ () ~t7.A" 17M <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />7791-1/71 <br /> <br />Fee Simple Titleholder Name <br /> <br />I <br /> <br />Fee Simple Titleholder Address I <br />!!im;_~~WlIil!!I>_. Wl3!P'T- <br /> <br />FIX: G,4LL BLVD <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />FL <br /> <br />CffrrTTEReoX <br />I <br /> <br />1'__~"'liW"'"_'IIIIIllJim~'- <br /> <br />~~ <br /> <br />Contractor <br /> <br />Signature <br /> <br />Address I <br /> <br />ELECT. RICIANI <br /> <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 />~d~;:ss L... . <br />Directions: <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />Sic-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 L-J <br />Fire Alarm D 0 0 0 C=:J <br />Hood Cleaning G:ZI 0 I2f' 0 C=:J <br />Hood Suppression D 0 0 0 C=:J <br /> <br />liillr-n- <br /> <br />Parcel # <br /> <br />r ? <br /> <br />D <br />o <br />D <br />D <br />o <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />Fax-813-780-0021 <br /> <br />II <br /> <br />II <br /> <br />C7?t-E <br /> <br />I Lot# <br /> <br />'I <br /> <br />Fire Alarm Installation <br /> <br />Fire Pumps <br />Fire Works <br /> <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />--w~\~1l:l4.J1 <br /> <br />~~"'- <br /> <br />I;;. <br /> <br />Wl~~""'~""~J <br /> <br />Fumigation Tent <br />Hazardous Material (Tier II or RQ Facility) ANNU~" <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 /> <br />Sparklers <br />Sprinkler System Installations <br />Standpipes (Sprinkler Sys) <br />Torch RoofinglTar Kettle <br />Waste Tire Storage ANNUAL <br /> <br />. ,CD <br />");./IIP) vL-Y"" - r ) <br />.:7< ~ -/,3 --- D~ <br /> <br />Valuation of Project <br /> <br />K!mIIIlII!~ <br /> <br />UIJ <br /> <br />~ v- r' 1l.."lflllW J..JJ L. Fl <br /> <br />t2m~.lJ. <br /> <br />~_r1 <br /> <br />D <br />D <br />D <br />B <br />D <br />l <br /> <br />Ic/~ <br /> <br /> Company <br /> Registered <br /> License # <br /> Company <br /> Registered <br /> License # <br /> Company <br /> Registered <br /> License # <br /> I Company <br /> Registered <br /> I License # <br /> I Company <br /> Registered <br /> IJ License # <br />~.- -,. <br /> <br />Other: <br /> <br />~ <br /> <br />^'6 """"lil<.~~~""'-If <br /> <br />.'- ~ <br /> <br />LillLLJ~!l5I<Se i~V/CbS <br />IYTNl Fee Current Y I N I <br />I I <br /> <br />I Y IN <br />I <br /> <br />I Y IN <br />I <br /> <br />I Y/N <br />I <br /> <br />I Y/N <br />I <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y I N I <br />,,"~J <br /> <br />--w't{~; <br /> <br />'.;f~~'~'~'ilJ(-~ '~".n~ <br /> <br />~~ ~""" <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 />