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<br />City of Zephyr hills Fir;e
<br />Permit Application
<br />Da"teF1.ec:iv~,~n... J ~~L L-C) X-- L.. .' "'. .. . ..." ...~~~ne Contact for pe~it"",~I? l ') U 6I'p IJ G 0 ~'"'] I
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<br />I I Own~'s Phone Number I II 1.1 I
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<br />Fee Simple Titleholder Name Titleholder Phone Number . . . .
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<br />813-780-0020
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<br />Owner's Name
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<br />Owner's Address
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<br />Fee Simple Titleholder Address
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<br />Job Address
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<br />If J JOWl <. J/
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<br />p' 0"bfk
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<br />Fax-813-780-0021
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<br />Lot#
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<br />Sub Division
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<br />Parcel #
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<br />Contractor
<br />Signature
<br />Address I
<br />ELECTRICIANI
<br />Signature
<br />Address I
<br />PLUMBER
<br />Signature
<br />Address I
<br />MECHANICALI
<br />Signature .
<br />Address I
<br />OTHER
<br />Signature
<br />Address J
<br />~~~~.-
<br />Directions:
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<br />~~____~.&iilit
<br />Company I
<br />Registered Y I N
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<br />License # I
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<br />Company I
<br />Registered Y I N
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<br />License # I
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<br />Company I
<br />Registered Y I N
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<br />License # I
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<br />I Y IN
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<br />License # I
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<br />Company I
<br />Registered Y I N
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<br />._".,.,,,,.~~==,~~~..aL,,~~. ..,.".."'.."'_.,.w.".....,..,,_,.,""',..!"",1~j
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<br />Bic-Hazard Waste Storage -ANNUAL
<br />Comm Exhaust Kitchen Hood/Duct
<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 lit 0 0 L-J
<br />Fire Alarm 0 0 0 0 c=:I
<br />Hood Cleaning 0 0 0 0 c=:I
<br />Hood Suppression 0 0 0 0 c=:I
<br />Fire Alarm Installation
<br />Fire Pumps
<br />Fire Works
<br />Flammable Application- ANNUAL
<br />Fuel Tanks
<br />Other:
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<br />D Fumigation Tent
<br />D Hazardous Material (Tier II or RQ Facility) ANNUAL
<br />D Hood Installation
<br />D LP/Natural Gas-Installation
<br />D LP/Natural Gas-ANNUAL Sale
<br />D Places of Assembly-ANNUAL
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<br />D Recreational Bum
<br />D Sparklers
<br />D Sprinkler System Installations
<br />D Standpipes (Sprinkler Sys)
<br />D Torch RoofingfTar Kettle
<br />D Waste Tire Storage ANNUAL
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<br />Valuation of Project
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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 />Fee Current
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<br />Y/N
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<br />Company
<br />Registered
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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 />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)
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