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<br />813-780-0020 <br /> <br />'~~~:'~;I~;i~:~,,~W ,,;;,) p,' <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />. (, tl, <br />City of ZephyrhillsFire '* {)Dl1 Fax-813-780-0021 <br />Permit Application /V\ ~1E.1<. Rs/2.tv\ I,: =J (y ~ 4 <br /> <br />jjiWimi,jmWilI\!%nWIi%~w*,w1%<1Wm~<i1@11\!(l""'~'1_MMW(lf&*Mi!\%I$\t!MWi~i~~~:"~~!~:~,;~~~;~::~~,tf~112:i,-lJ2~",,L12,!~J <br />172=1- 11~llo25U2J <br /> <br /> <br />~;",.:",'J'::',""~j'" <br /> <br />~~~;W<':~:"':;\;;% <br /> <br />---ze <br /> <br />Fee Simple Titleholder Name <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />Contractor <br />Signature <br /> <br />Address I <br /> <br />ELECTRICIANl <br /> <br />Signature <br /> <br />Address I <br /> <br />ZErfl,/Rh"II<,. Fl..~42 31c.~ Lot' I I <br />, I parcel; 102-2& -2J-m/o-0.24'aJ-a>/d <br /> <br />D Fumigation Tent <br />D Hazardous Material (Tier II or RQ Facility) ANNUAL <br />~ Hood Installation <br />D LP/Natural Gas-Installation <br />D 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 />D Torch RoofinglTar Kettle <br />D Waste Tire Storage ANNUAL <br /> <br />10 't3'-/ boJ \ <br />NJA <br /> <br />(?)\ vd . <br /> <br />k~~5W.ml <br /> <br />Valuation of Project <br /> <br />Bio-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-J <br />Do ooc=J <br />Doooc=J <br />Doooc=J <br /> <br />Fire Alarm <br /> <br />Hood Cleaning <br /> <br />Hood Suppression <br /> <br />D <br />B <br />B <br />D <br />I <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 />Company <br />Registered Y/N I Fee Current Y/N <br />License # <br />Company <br />Registered Y/N I Fee Current Y/N <br />License # <br />Company <br />Registered Y/N I Fee Current Y/N <br />License # <br />Company ~ "'~ fY1t::il1ANICAL <br />Registered ')! N Fee Current I Y I N <br />License # c.At..OS-2 L-/3GL <br />Company <br />Registered Y/N I Fee Current Y/N <br />License # <br /> <br />PLUMBER <br />Signature <br /> <br />Address ~ 1 <br /> <br />MECHANICAL ~ l <br />Signature _ ' <br /> <br />Address I u3-'3'-1 / /5!:-I-h <br /> <br />OTHER <br />Signature <br /> <br />Address <br />Directions: <br /> <br />AVE ,. L.iRl2.fp ) F /... .331- ':1-3 <br /> <br />Fill out application completely. <br />Owner & Contractor sign back of applicaticm, notarized (Or, copy of signed contract with owner) <br />If over $2500, a Notice of Commencement is required (Mechanical work over $5000) <br />Suppiy two (2) sets of drawings witb applicable pocumentation <br />Allow 10.14 days for review after sub~!~~I,~~t~i Parcel # - obtained from Property Tax Notice (http://appraiser.pascogov.com) <br />