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<br />813-780-0020 'f) 0<2 City of Zephyr hills .Fire Fax-813-780-0021
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<br />15J 'XT'tI- A-c1 '-1\104..~ ~ (: ~ ,q.A'~ Owner's Phone Number I .3 rz.... II -V7' 1,\1 -fo.O I
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<br />I Titleholder Phone Number I
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<br />Owner's Name
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<br />Owner's Address
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<br />Fee Simple Titleholder Name
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<br />Fee Simple Titleholder Address
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<br />Job Address
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<br />Sub Division
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<br />Bio-Hazard Waste Storage -ANNUAL
<br />Comm Exhaust Kitchen HoodlDuct
<br />Controlled Bum
<br />Emergency Generator < 30 kw
<br />Emergency Generator> 30 kw
<br />Fire Protection Maintenance - ANNUAL
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<br />Sprinkler 0 0 0 0 L-.J
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<br />Fire Alarm 0 0 0 0 c:=:I
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<br />Hood Cleaning 0 0 0 0 c:=:I
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<br />Hood Suppression 0 0 0 0 c:=:I
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<br />Fire Alarm Installation
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<br />Fire Pumps
<br />Fire Works
<br />Flammable Application- ANNUAL
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<br />Fuel Tanks
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<br />Other:
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<br />Lot#
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<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
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<br />Recreational Bum
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<br />Sparklers
<br />Sprinkler System Installati
<br />Standpipes (Sprinkler Sys)
<br />Torch Roofing/Tar Kettle
<br />Waste Tire Storage ANNUAL
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<br />Valuation of Project
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<br />Contractor
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<br />Signature
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<br />Address I
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<br />ELECTRICIAN]
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<br />Signature
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<br />Address I
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<br />PLUMBER
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<br />Signature
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<br />Address I
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<br />MECHANICAL]
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<br />Signature .
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<br />Address I
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<br />OTHER
<br />Signature
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<br />Directions:
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<br />Company I
<br />Registered
<br />License # I
<br />Company I
<br />Registered
<br />License # I
<br />Company I
<br />Registered
<br />License # I
<br />Company I
<br />Registered
<br />License # I
<br />Company I
<br />Registered
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<br />Y/N
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<br />Y/N
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<br />Fee Current
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<br />Y/N
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<br />Y/N
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<br />Fee Current
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<br />Y/N
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<br />Y/N
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<br />Fee Current
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<br />Y/N
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<br />Y/N
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<br />Fee Current
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<br />Y/N
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<br />Y/N
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<br />Fee Current
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<br />Hf'nilt'~'
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<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 />Aliow 10-14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http://appraiser.pascogov.com)
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