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<br />.813-780-0020 <br /> <br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />'0- \ 0.- D> <br /> <br />City of Zephyr hills Fire <br />Permit Application <br /> <br />Phone Contact for Permit <br /> <br /> <br />Fax-813-780-0021 <br /> <br />7J ~ <br />~iJ1tL ('oj r.; L C~u,;J... of l--II, j6 Owner's Phone Number <br /> <br />51 Z-IJ~//.J <br /> <br />I ~II' S tG iI~ f1J (fJd ~ In 5 I Titleholder Phone Number I ~ I 3 <br />I <br /> <br />104>~~~d~ <br />152.o~ ft!- <br /> <br />IK/3 <br /> <br />II II :Sfzz.., I <br />I <br />11114 11:3 i z, 2-1 <br />I <br /> <br />Fee Simple Titleholder Name <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />~ S\-. <br /> <br />Sub Division <br /> <br />5~ D<tS' <br /> <br />I Lot# <br /> <br />11I-2l.c- ~\- COlO.' l8~ao.. D~ I <br />\ Utll AII"eU rKUM t"'KUt"'~K I Y I IV.. I"U live <br /> <br />Parcel # <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br />Comm Exhaust Kitchen Hood/Duct <br />Controlled Bum <br /> <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 />[g] Places of Assembly-ANNUAL <br />D Recreational Bum <br />D Sparklers <br />D Sprinkler System Installations <br />D Standpipes (Sprinkler Sys) <br />D Torch Roofing <br />D Waste Tire Storage ANNUAL <br /> <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />Sprinkler D <br />Fire Alarm D <br />Hood Clean/Suppression D <br />Fire Alarm Installation <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />Valuation of Project <br /> <br />Other: <br /> <br />Contractor <br />Signature <br /> <br />Address I <br /> <br />ELECTRICIAN <br />Signature I <br /> <br />Address I <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br />Signature . <br /> <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />Address <br />Directions: <br /> <br />Company <br />Registered <br /> <br />Y I N I Fee Current <br /> <br />Y/N <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y I N Fee Current <br /> <br />Y/N <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y I N I Fee Current <br /> <br />Y/N <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y I N I Fee Current <br /> <br />Y/N <br /> <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y I N I Fee Current <br /> <br />Y/N <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. <br />