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<br />813-780-0020 <br /> <br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />City of Zephyrhills Fire <br />Permit Application <br /> <br />Phone Contact for Permit <br /> <br />-tt 1l ?'1Fax-813-780-0021 <br /> <br /> <br />Fee Simple Titleholder Name <br />Fee Simple Titleholder Address <br /> <br /> <br />Owner's Phone Number <br /> <br />?13 117g311f09? I <br /> <br />I Titleholder Phone Number I <br /> <br />II <br /> <br />II <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />S'61 7 <br /> <br />a ~ /....L.:2 LiID <br /> <br />Parcel # <br /> <br />I Lot# <br /> <br />(l~ ~~u-?i: 9~u~~~~DIB:~~ ~~ ( () <br /> <br />o <br />o <br />o <br />o <br />o <br />o <br /> <br />o <br />o <br />o <br />D <br />D <br />D <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br /> <br />Comm Exhaust Kitchen Hood/Duct <br /> <br />Controlled Bum <br /> <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br /> <br />Sprinkler <br />Fire Alarm <br />Hood Clean/Suppression <br />Fire Alarm Installation <br /> <br />D <br />D <br />~ <br /> <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />Other: <br /> <br />I &7 m,)lI/T-H .StJ.;pPe-S.-\/lW <br /> <br />b~_A~ ~ t <br /> <br />~~~:~~::r V0~ <br /> <br />Address i NL<;3~ LA/. )2~N~ YO <br />. .. 1- <br />ELECTRICIAN <br /> <br />Signature <br /> <br />Address I <br /> <br />PLUMBER <br /> <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br /> <br />Signature . <br /> <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />I <br />.J P,.:.-- G-.y I <br /> <br />I <br />I <br />, <br />I <br />I <br />I <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />Fumigation Tent <br />Hazardous Material (Tier" or RQ Facility) ANNUAL <br />Hood Installation <br />LP/Natural Gas-Installation <br />LP/Natural Gas-ANNUAL Sale <br />Places of Assembly-ANNUAL <br /> <br />Recreational Bum <br /> <br />Sparklers <br />Sprinkler System Installations <br />Standpipes (Sprinkler Sys) <br />Torch Roofing <br />Waste Tire Storage ANNUAL <br /> <br />Valuation of Project <br /> <br />~v.s""~n7 IJJ'1AIJvrl'-.~<'1A/cP:;: I <br />L",,"~~..~.1)_ ~ " ~mf"-"~<mm. ~1:W~ <br />Company I ~C02r?y f71?e:=" /Fqo. PQ1j-I'.,rr I <br />Registered . _ N I Fee Current I Y IN. <br /> <br />License # i"" =~ '" QOC\ 2<'1'>(\ V : <br /> <br />Company <br />Reg;"."" . Y I N ~ Fee Curren' I Y IN: <br /> <br />License # I I <br /> <br />Company <br />Registered <br /> <br />Y/N , <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y/N I <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Company <br />Registered <br /> <br />Y IN I <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />License # <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 />