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<br />City of Zephyrhills Fir-e * <0 b 1-- I <br />~fl Perm" Application l' ::; -'g' - <br /> <br />t2~~~(~7&:-r==~.~f{~'~'~~:.':brJ <br /> <br />~kt L 76VV;;J, ! <br /> <br />I Titleholder Phone Number I II II I <br />I <br /> <br />I <br />I <br /> <br />813-780-0020 <br /> <br />..a.....!.~!~l.';:'~!,~~'~:"fa""i.W!l"Ji" .,., <br />"l'~';,'::':~'%. """>-_"".M",~-,;<<o->;,,,^'>,.'''''m'''''''Y'~''''''' :'."'..,,' <br /> <br />Owner's Name" i <br /> <br />Owner's Address <br /> <br />53'11 <br />I <br />I <br />'3 '11 <br /> <br />~tv2J, <br /> <br /> <br />Lot# <br /> <br />Fee Simple Titleholder Name <br /> <br />Fee Simple Titleholder Address <br /> <br /> <br />Job Address <br /> <br /> <br />Fax-813-780-0021 <br /> <br />5s5"Vz- <br /> <br />Sub Division <br /> <br />Parcel # <br /> <br />D Bio-Hazard Waste Storage - ANNUAL <br />~ Comm Exhaust Kitchen Hood/Duct <br />o Controlled Bum <br />D Emergency Generator < 30 kw <br />D Emergency Generator> 30 kw <br />D Fire Protection Maintenance - ANNUAL <br />~~~~ <br />Sprinkler D 0 0 0 L-J <br />Doooc=J <br />Doooc=J <br />Do ooc=J <br /> <br />Fire Alarm <br /> <br />~OOd Cleaning <br /> <br />ood Suppression <br /> <br />Fire Alarm Installation <br /> <br />D Fire Pumps <br /> <br />D Fire Works <br />D Flammable Application- ANNUAL <br /> <br />D Fuel Tanks <br /> <br />D Other: <br /> <br />Contractor ! <br />Signature . <br /> <br />Address <br /> <br />ELECTRICIANI <br /> <br />Signature <br /> <br />Address I <br /> <br />D Fumigation Tent <br />D Hazardous Material (Tier II or RQ Facility) ANNUAL <br />D 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 RoofingfTar Kettle <br />D Waste Tire Storage ANNUAL <br /> <br />3 ~ 00 ~ Valuation of Project <br /> <br />I <br /> <br />-::::z~ <br /> <br />~~K~ <br /> <br />PLUMBER <br />Signature <br />Address I <br />MECHANICALI <br />Signature <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />Address <br /> <br />~ Company <br />. ~egistered <br /> <br />. b L~nse# <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br /> <br />Y I N I Fee Current <br /> <br />Y/N <br /> <br />Company <br /> <br />Registered <br /> <br />License # <br /> <br />Y I N I Fee Current <br /> <br />Y/N <br /> <br />Company <br /> <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Y I N Fee Current <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y / N I Fee Current <br /> <br />Y/N <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 />