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<br />8113-780-0020 <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 />- (3 - .;;J.oo, <br /> <br />IChr /,. ~ !3lJl, j 6-1' ttl A0-;~ <br />I G;\\("OCNl <br /> <br />I <br />I <br />I 7~ it3 <br />I <br /> <br />Fee Simple Titleholder Name <br /> <br />Fax-813-780-0021 <br /> <br /> <br />~&,6.l <br /><6 fc"::, II dPI'4 IA 555 <br /> <br />Phone Contact for Permit <br /> <br />Owner's Phone Number <br /> <br />I Titleholder Phone Number I <br /> <br />II <br /> <br />II <br /> <br />-- <br /> <br />iWlIr~ <br /> <br />- <br /> <br />-~. l::a:li.ilI <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />~~~~1iII t< ......-nltbt!~- <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 />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 />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 ANNUAL <br /> <br />~J/ <br /> <br />f3/v ! <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 />Sprinkler D <br />Fire Alarm D <br />HoodClea~ <br />Fire Alarm Installation <br /> <br />Fire Pumps <br /> <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />Parcel # <br /> <br />I Lot# <br /> <br />~Ub IAII'lt:U r-I"(UIVI t"'KUt"'t:1"( I Y I A^ I'lU 111",t:) <br />nlill 1T~ T!I ~rtlllf Ii !!~. <br /> <br />J1~~ <br /> <br />., Valuation of Project <br /> <br />Other: <br /> <br />Contractor <br />Signature <br /> <br />Address <br /> <br /> <br />ELECTRICIAN <br />Signature I <br /> <br />Address I <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANiCAL! <br />Signature I <br /> <br />Address I <br /> <br />OTHER <br />Signature <br />Address I <br />ld_~' -. W""'''''\;j."""",,,,..,.=,~,,,...:.,=-..,,,,,-- ;'''''''''''''''''''''-'''''--'''-'-''''',''="V'.~'~"",.^",_,=='",,_,-,,=._...~. _~'__.~. <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 />=""".''''''-' <br /> <br />~ ,~_,.,-.,.I <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />I ~(1"YlSL,kv b-t.n"'"'- " <br />Y I ~ I Fee Current I Y I N <br />I <br /> <br />I Y I N I Fee Current <br /> <br />I <br /> <br />I Y IN <br />I <br /> <br />r Y IN' <br />I <br /> <br />I Y I N I Fee Current <br />L <br /> <br />Y/N <br /> <br />'-'-"'.~. ."",-.~ <br /> <br />Y I N I <br />I <br /> <br />Y IN I <br />I <br /> <br />Y I N I <br /> <br /> <br />. wy.", . ,,,,,,... '.... ..~,_'"_,...="', '. .! <br /> <br />Fee Current <br /> <br />Fee Current <br /> <br />~ <br />