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<br />~116v <br /> <br />Date Received <br /> <br /> <br />City of Zephyrhills Fire <br />Permit Application <br /> <br />Phone Contact for Permit <br /> <br /> <br />813-780-0020 <br /> <br />Owner's Name <br /> <br />-0 <br />:. l:1tlnA4 / JlJ'leI <br /> <br />Owner's Address <br /> <br />Fee Simple Titleholder Name <br /> <br />Fax-813-780-o021 <br /> <br />Owner's Phone Number <br /> <br />II <br /> <br />II <br /> <br />I Titleholder Phone Number I <br /> <br />II <br /> <br />II <br /> <br />Fee Simple Titleholder Address <br /> <br />Ie; TII 5/ <br /> <br />Job Address <br /> <br />I 54/<6 <br />I <br /> <br />ZfiP HyP. }/II..LS <br />I Parcel # <br /> <br />Sub Division <br /> <br />o Bio-Hazard Waste Storage - ANNUAL <br />D Comm Exhaust Kitchen Hood/Duct <br />D Controlled Bum <br />D Emergency Generator < 30 kw <br />o Emergency Generator> 30 kw <br />o Fire Protection Maintenance - ANNUAL <br />Sprinkler D <br />Fire Alarm D <br />Hood Clean/Suppression D <br />Fire Alarm Installation <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />o <br />D <br />D <br />D <br />D <br />D <br />c~ntractor ! <br />Signature . <br /> <br />Address <br /> <br />ELECTRICIAN <br />Signature I <br /> <br />Address I <br /> <br />PLUMBER I <br /> <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />33SLfd-. <br />I <br /> <br />I Lot# <br /> <br />(!~::c: !!u7~~!u~;~f~u~~P <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 />Other: <br /> <br />~ <br /> <br />I~ <br /> <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br /> <br />Signature <br /> <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />Company <br />Registered <br /> <br />BOLT/~ PEST C;:;"vrev<.- <br />Y I N I Fee Current I Y I N <br /> <br />I~ <br />I <br />I <br />I <br />I <br /> <br />License # <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 />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 />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 />