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<br />813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br />Permit Application <br /> <br />m~~~~'IM@1fA1L_#.~Ltfl- ~,,,.._,,,~,LJ.,,"__,,,,,...U,,,,~,,,,,,,,,,,,,","J <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />~frill.J ~~/ I Owner's Phone Number <br />S-fI'..Lek I "2 ~/,kVfh,'lIS f r/' <br /> <br />I Titleholder Phone Number <br /> <br />I 2 J S 117 g :g II /? 5"'1 <br />33SC/Z <br />I II II <br /> <br />I Z t:t'A'I rh I tis <br />I '1330 Jo ~ <br />I <br />I <br />,Y33o <br />I <br /> <br />Fee Simple Titleholder Name <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />d2>-j;. <br /> <br />S.bwf <br /> <br />I Lot# <br /> <br />Parcel # <br /> <br />\ Uti I AII'llt:U rKUlV1 t"KUt"t:K I T I tv. I'IIU 11L.t:) <br /> <br />D <br />D <br />D <br />D <br />D <br />~ <br /> <br />~ <br />D <br />D <br />D <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br /> <br />Comm Exhaust Kitchen HoodlDuct <br />Controlled Bum <br /> <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />Sprinkler ~ <br />Fire Alarm D <br />Hood Clean/Suppression D <br />Fire Alarm Installation <br />Fire Pumps <br />Fire Works <br /> <br />(JrtlL Y <br /> <br />D Fumigation Tent <br />D Hazardous Material <br />D Hood Installation <br />D LP/Natural Gas-Installation <br />D LP/Natural Gas-ANNUAL Sale <br />D 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 <br /> <br />Other: <br /> <br />Contractor <br />Signature <br />Address <br /> <br /> <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />OTHER <br />Signature <br />Address <br />Directions: <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />ELECTRICIAN <br /> <br />Signature <br /> <br />Address I <br /> <br />I <br /> <br />PLUMBER <br /> <br />Signature <br /> <br />Address I <br /> <br />MECHANICA~ <br /> <br />Signature <br /> <br />Address I <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Y I N Fee Current <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 />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 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 />