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<br />813-71iO-0020 <br /> <br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />Fax-813-780-0021 <br /> <br />City of Zephyrhills Fire <br />Permit Application <br /> <br />Phone Contact for Permit <br /> <br />(0-' ?>\-o <br /> <br /> <br />~~~~J~ ~ <br /> <br /> <br />Fee Simple Titleholder Name \ <br /> <br />I <br />Job Address '--=7 ~5 ~~ (2d <br />I <br /> <br />Fee Simple Titleholder Address <br /> <br />Sub Division <br /> <br />D <br />D <br />D <br />D <br />D <br />D <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 />Parcel # <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br /> <br />D <br />D <br />D <br />D <br />~ <br />D <br />D <br />D <br />o <br />o <br />o <br /> <br /> <br />113\~ II'/~ I L~I R-~ I <br /> <br />: <br />I <br />I <br />I <br />tUl:HAINl:U r-KUIVII"'KUI"'l:KI Y IfV'. NU~:~,~_ <br /> <br />Owner's Phone Number <br /> <br />I Titleholder Phone Number I <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 />D <br />D <br />D <br />D <br />D <br />D <br /> <br />Sprinkler <br />Fire Alarm <br />Hood Clean/Suppression <br />Fire Alarm Installation <br /> <br />D <br />o <br />o <br /> <br />II <br /> <br />II <br /> <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />~Tlr;~Ln= fEJ!r~..I~ <br /> <br />I Lot# <br /> <br />Fumigation Tent <br />Hazardous Material (Tier II 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 />Other: <br /> <br />Valuation of Project <br /> <br />Company I <br />Registered Y I N I Fee Current <br /> <br />License # I <br /> <br />Company I <br />Registered Y I N <br /> <br />License # I <br /> <br />Company I <br />Registered Y I N I Fee Current <br /> <br />License # I <br /> <br />Company I <br />Registered Y I N <br /> <br />License # I <br /> <br />Company I W2:0' ~'S {i-({~ <br />Registered C:rd N 1 Fee Current ,( Y ] N I <br /> <br />~t;t@>~~"",~~,--~",,,,,,-~ <br /> <br />.J <br />I <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />I~QY <br />~~~~_~~,!:!~,JC~~ <br />Directions: <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 /> <br />OTHER <br /> <br />Signature <br />