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<br />Date Received <br /> <br />Owner's Name' <br /> <br />Owner's Address <br /> <br />813-780-0020 <br /> <br />#e(v~ <br /> <br />City of Zephyrhills Fir:e. <br />Permit Application <br /> <br /> <br />Fee Simple Titleholder Name <br />Fee Simple Titleholder Address I <br /> <br />Job Address )' <) 0 ~ <br />Sub Division <br /> <br />Fax-813-780-0021 <br /> <br />Phone Contact for Permit <br /> <br /> <br />Owner's Phone Number <br /> <br />Titleholder Phone Number I <br /> <br />II <br /> <br />II <br /> <br />Parcel # <br /> <br />J <br /> <br />I Lot# <br /> <br />I <br /> <br />~ ~~,~~~,'"~""O" <br /> <br /> <br />D Other: I <br /> <br />~:U':' b ~7, r ~ <br /> <br />Address _. c) '-- 75ifS" <br /> <br />ELECTRICIANI <br />Signature <br /> <br />Address I <br /> <br />PLUMBER <br /> <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br /> <br />Signature <br /> <br />Address I <br /> <br />OTHER <br /> <br />Signature <br /> <br />Address <br /> <br />D <br />~ <br />D <br />D <br />D <br />D <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br />Comm Exhaust Kitchen Hood/Duct /)"-ff'~4........ <br />Controlled Bum <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />~~~~ <br />Sprinkler 0 0 0 0 L-J <br />Fire Alarm 0 0 0 0 c==I <br />Hood Cleaning 0 0 0 0 c==J <br />Hood Suppression 0 0 0 0 c==J <br /> <br />o <br />o <br />o <br />o <br />D <br />o <br />D <br />D <br />D <br />D <br />o <br />o <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 />Sprinkler System Installations <br />Standpipes (Sprinkler Sys) <br />Torch RoofingfTar Kettle <br />Waste Tire Storage ANNUAL <br /> <br />Fire Pumps <br /> <br />Fire Works <br /> <br />Flammable Application- ANNUAL <br /> <br />~2JCf)OeJ <br />, <br /> <br />Valuation of Project <br /> <br />Company <br />Registered <br />License # <br /> <br />clr''CQ.. \-\1.VI+~J J/lC-, <br />r N I Fee urrent I Y I N I <br /> <br />O/~ ')0 5'00" /~7 I <br /> <br /> <br />Y I N Fee Current Y I N I <br /> <br />I <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br /> <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />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 />