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<br /> <br />813-780-0020 <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />City of.Zephyrhills"Fir:e' <br /> <br /> <br />Fee Simple Titleholder Name <br />Fee Simple Titleholder Address <br /> <br />o <br /> <br /> <br />EI Fuel Tanks <br /> <br />o Other: I <br />w_~"'l1 ~.)i'~t~~l.-rr~'~ lllUJ:Jj -~,~- Ii' - Ittn <br /> <br />~~::; ! ~'a11 !!i #/fIeJd\M1 ~tI,f7IY~ <br />Address. ? ::f(.A) IfCZtLcf ~ fE( W r 17J:7 r ~ ~(j> 0 ~ <br /> <br />ELECTRICIAN] I <br />Signature . <br /> <br />Address I I <br /> <br />I <br />I <br />I <br />I <br />I <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />o <br />D <br />o <br />o <br />o <br />o <br /> <br />PLUMBER <br /> <br />Signature <br />Address I <br />MECHANICAL] <br />Signature <br />Address I <br /> <br />OTHER <br /> <br />Signature <br /> <br />~~dre~~cL,.. <br />Directions: <br /> <br />c <br /> <br />". ~~~~:!i.%~~I~1Ijj['!':~~lm' <br /> <br />"I <br />lo~-d6-J.( "(/O(O~O;),l.fCtJ-oO( 0 <br /> <br />,. . ...,,, . ........ .- <br /> <br />Lot# <br /> <br />Bia-Hazard Waste Storage -.ANNUAL <br />Comm Exhaust Kitchen Hood/Duct <br />Controlled Bum <br /> <br />o <br />o <br />D Hood Installation <br />D LP/Natural Gas-Installation <br />D 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 />~3,60 <br /> <br />Fumigation Tent <br />Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />. ~~~~ <br />Do ooL-] <br />Do ooc=J <br />Doooc=J <br />Do ooc=J <br /> <br /> <br />Hood Suppression <br /> <br />Fire Alarm Installation' <br /> <br />Torch RoofinglTar Kettle <br />Waste Tire Storage ANNUAL <br /> <br />Fire Pumps <br /> <br />Fire Works <br /> <br />Flammable Application- ANNUAL <br /> <br />I <br /> <br />Valuation of Project <br /> <br />~~v- <br /> <br />License # <br /> <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />-''''V'''' <br /> <br />t5F-- 80(5)00 'f:3 Cf <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Company <br /> <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Company <br />Registered <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />License # <br /> <br />Y/N <br /> <br />Fee Current I Y / N I <br /> <br /> <br />'.,. ..'""'~""""",,,.i'"''''."''''_..''' "....,~J <br /> <br />.......on=_ <br /> <br />"""~n,,~~';;'M'il"{"'1iA-'~v <br /> <br />"'~'''.'''.' "',f'<<'--'" <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 />