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<br />rel~~l~o~ta,c=_l__.Jl. ,......._"."lL.".".",..~,-, <br />'I f/:3 Il1ro 1.'100,30 <br />/ '15 9~5~r <br /> <br />I Titleholder Phone Number I 1'1 II <br /> <br /> <br /> <br />~~~j~;~(~ <br />_ .. __ .,_-C.-....- .~,- <br />D <br />D <br />D Hood Installation <br />o 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 <br />D <br /> <br /> <br />B.13-78u-~20 <br /> <br />City of.Zephyrhills 'Fir,e <br />Permit Application <br /> <br />l~~~:;ji~~~,~~~:~.t"''''''Jj",~L,.?L!.U,~L~_._.J " <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />Fee Simple Titleholder Name <br />Fee SimPleTitlehold~ <br /> <br />=.139J~?--4'~ <br /> <br />""I*,,"_'~',,<'Y!~.>l!<~_. .~""''''.'-'---'. I,,~,,~,_-~ -= <br />~'("~"1',~~:.'i~:;lw..'\'lI'~,"m;~~~~~~;r>:;J-~~~'M' --"""1 <br />o Bio-Hazard Waste Storage -ANNUAL <br />o Comm Exhaust Kitchen Hood/Duct <br />D Controlled Bum <br />D <br />D <br />D <br /> <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />. ~~~~ <br />Sprinkler ~ 0 0 E L-l <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 <br /> <br />~ <br /> <br />D <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 />~ 5!?~{ <br /> <br />Fax-813-780-0021 <br /> <br />Fumigation Tent <br />Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> <br />Torch RoofingfTar Kettle <br />Waste Tire Storage ANNUAL <br /> <br />I <br /> <br />Valuation of Project <br /> <br /> <br />~' <br /> <br />Contractor <br />Signature <br /> <br />A ddreM 1'<1/0 l~r.,#~~$"IJ"'~) PI. <br /> <br />ELECTRICIAN <br />Signature <br /> <br />Address I <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANICAL] <br />Signature . <br /> <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />Address. I <br />~- Jf~ <br />Directions: <br /> <br />',',",;i.-, <br /> <br />"4l....f#V'w~ <br /> <br />i <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br /> <br />-.-."--.,,.L., <br /> <br />~'f.,q ~J4'J) <br /> <br />.,......"""~~"-..... <br /> <br />"rTr"~~;';';'."~v .'''''''.'''''''''"~ <br /> <br />.~~lffl!I~h==' <br /> <br />Company I <br />Registered Y I N <br /> <br />License # I <br /> <br />Company I <br />Registered Y I N <br /> <br />License # I <br /> <br />Company I <br />Registered Y I N <br /> <br />License # I <br /> <br />Company I <br />Registered Y I N <br /> <br />License # I <br /> <br />Company ] <br />Registered Y I N I Fee Current I Y I N I <br /> <br /> <br />Licen~~ # J ... ,,,,, ,. p,...~",""'~__"" =_,_, ,..,."".."".."~.,._",,""....J <br /> <br />~j!l:~~W <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />-""~.. <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 />