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<br />City of Zephyr hills -Fir:e <br />Permit Application <br /> <br />"~~~:i~;~:~~~'~f";"J~m._I...,,~,.,..",,~,*,.,,~~._,~.",=..du____-~~~~~=~~~r;:g0,J"",*1.~,211~LiJl~!:.~~,~~'i..1 <br />10; 2.L ~ ~~ I Own~~s Phone Number ., II 1,1 I <br /> <br />813-780-0020 <br /> <br />Owner's Name <br /> <br />let&6 <br /> <br />Fax-813-780-0021 <br /> <br />Owner's Address <br /> <br /> <br />II <br /> <br />II <br /> <br />Fee Simple Titleholder Name <br /> <br />Job Address <br /> <br />I <br />I Lv s- J-f<{ <br />I <br /> <br />6-0-11 <br /> <br />Fee Simple Titleholder Address <br /> <br />r-- '~{-d Lot # <br /> <br />I <br /> <br />Sub Division <br /> <br />o Fumigation Tent <br />,;0 Hazardous Material (Tier II or RQ Facility) ANNUAL <br />: ~Od Installation <br />LP/Natural Gas-lnstallatiDn <br />o LP/Natural Gas-ANNUAL Sale <br />o Places of Assembly-ANNUAL <br /> <br />D Recreational Bum <br />D Sparklers <br />D Sprinkler System Installations <br />D Standpipes (Sprinkler Sys) <br />D <br />D <br /> <br />o <br />o <br />o <br />D <br />D <br />D <br /> <br />Bic-Hazard Waste Storage -ANNUAL <br />Comm Exhaust Kitchen HoodlDuct <br />Controlled Bum <br /> <br />Emergency GeneratDr < 30 kw <br />Emergency GeneratDr > 30 kw <br />Fire Protection Maintenance - ANNUAL <br />~~~~ <br />Sprinkler D 0 0 0 L-.J <br />Do ooc=J <br />Doooc=J <br />Do ooc=J <br /> <br />Fire Alarm <br /> <br />Hood Cleaning <br /> <br />Hood Suppression <br /> <br />D Fire Alarm InstallatiDn <br />D Fire Pumps <br />B Fire Works <br />Flammable ApplicatiDn- ANNUAL <br /> <br />Fuel Tanks <br />D Other: I <br />m3~_l1!ll:~-"'...A <br /> <br />I <br /> <br />Torch RoofinglTar Kettle <br />Waste Tire Storage ANNUAL <br /> <br />D'()OD - <br /> <br />Valuation of Project <br /> <br />I' <br /> <br />Jiilj~;( <br /> <br />Contractor <br /> <br />Signature <br /> <br />Address I <br /> <br />ELECT. RICIANI <br /> <br />Signature <br /> <br />Address I <br /> <br />PLUMBER ! a <br />Signature II '--- <br /> <br />Address <br /> <br />MECHANICALI <br />Signature . <br /> <br />Address I <br /> <br />OTHER <br /> <br />Signature <br /> <br />Address <br /> <br />Directions: <br /> <br />License # <br /> <br />I Y/N <br />I <br /> <br />I Y I N <br />I <br />?ec~~ N~.'!I~ <br />I '() 1 N Fee Curren I <br />EiCL Dt;7-'f7 I <br /> <br />Y 1 N I Fee Current 71 <br />I <br /> <br />I Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y I N I <br />I <br /> <br />Y I N I <br />I <br />fJlCAf1bll7C- I <br />Y IN _ 0 <br /> <br />Y IN : <br /> <br />I <br /> <br />Company <br />Registered <br /> <br />Fee Current <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />CDmpany <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Fee Current <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 (htlp:llappraiser.pascogov.com) <br />