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<br />813-780-0020 <br /> <br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />City of Zephyrhills Fir-e <br />Permit Application <br /> <br />-10 ~JJ 1\ v~ uJ i e..~ ll.ifL-. Phone Contactfor Permit <br /> <br />f f3 D~ 1 <br /> <br />Fax-813-780-0021 <br /> <br /> <br />I <br />I <br />I '13% <br /> <br />Fee Simple Titleholder Name <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />bQI t ~Dr\ <br /> <br /> <br />19R.)l 11/77 II ?hS7 I <br />(J (it", $ f-ri--k ,zp' b1.6 <br />II I <br /> <br />Owner's Phone Number <br /> <br />I Titleholder Phone Number I <br /> <br /> <br />Parcel # <br /> <br />0'1 o=-- <br /> <br />, <br />I Lot# I I <br />135- ::s5- 2/-()()IO -{)fJBoo~ oo~o <br /> <br />Contractor <br /> <br />Signature <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 <br />D <br />D <br />D <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-J <br />Doooc=J <br />Do ooc=J <br />Do ooc=J <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />Fumigation Tent <br />Hazardous Material (Tier II or RQ Facility) ANNUAL <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 />Sparklers <br /> <br />Sprinkler System Installations <br /> <br />Standpipes (Sprinkler Sys) <br /> <br />Torch RoofingfTar Kettle <br />Waste Tire Storage ANNUAL <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br /> <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />U.~~.Ob <br /> <br />Valuation of Project <br /> <br />lSQ;lQJo..{\ <f ~Q..Jy~}rC Su-.tlcms~74 <br />L:!J N ee Current _ Y I NY- <br /> <br />EF,~CC:a\0H{O I <br /> <br />Y I N Fee Current Y I N I <br /> <br />I <br /> <br />tx::f Fire Alarm Installation <br /> <br />'D Fire Pumps <br />D Fire Works <br />D Flammable Application- ANNUAL <br /> <br />D Fuel Tanks <br /> <br />D Other: I <br /> <br /> <br />1~~1J <br /> <br />Address I 'SA \'1 ti e(Jl.ti~ IZ.- ~IQL<Ar <br />ELECTRICIANI <br />Signature . <br />Address I <br /> <br />Fire Alarm <br /> <br />Hood Cleaning <br /> <br />Hood Suppression <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Address I . License # J I <br />r~~~~~;;~~~~<~~:i>i;:~"";;:;A:*~~~,*::;;;~;<<.';';"-'x"""'---""'<<f---"-"'i;jji:~~;;iligi;j;";;~di:iiliii"",,'~<;;;il~<..:~~~~-a%"'t~~~~;..;;b"""'~-""'~~-""~~~".""",,~,,,.'ii""-'<.i:;\,~:'~,,~~dZ~m..'~1!WliiW}' <br />Directions: <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 />