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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 Zephyr hills Fire <br />Permit Application <br /> <br />Fax-813-780-0021 <br /> <br />Phone Contact for Permit <br /> <br /> <br /> <br />- Zd !xL \ cdo Owner's Phone Number <br /> <br />~(3 <br /> <br />II <br /> <br />II <br /> <br />I Titleholder Phone Number I <br /> <br />I <br />I <br />17QO 9 ?~'( f}/vJ. <br />I <br /> <br />Fee Simple Titleholder Name <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />I Lot# <br /> <br />Parcel # <br /> <br />~Ulj I AII'II~U r-KUIVI t"'KUt"'~K I Y I AA NU III.,,~~ _ <br /> <br />Bio-Hazard Waste Storage - ANNUAL <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 />o Standpipes (Sprinkler Sys) <br />D Torch Roofing <br />D Waste Tire Storage ANNUAL <br /> <br />-~ <br />Contractor Company I <br />Signature Registered <br />A,,,,,,,, ;"n"" ~Ia.r $(.. '7C-;..J'- FI- ~)610 i License # I <br /> Company I <br />ELECTRICIAN Registered <br />Signature <br />Address I I License # I <br />PLUMBER I Company I <br />Signature Registered <br />Address I .1 License # I <br />MECHANICALI I Company I <br />Signature Registered <br />Address I I License # I <br />OTHER I Company I <br />Signature Registered <br /> License # <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />o <br />D <br />D <br />o <br />o <br />D <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 0 <br />Fire Alarm D <br />Hood Clean~ B- <br />Fire Alarm Installation <br /> <br />Fire Pumps <br /> <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />Valuation of Project <br /> <br />I <br /> <br />E'f <br /> <br />I <br /> <br />Other: <br /> <br />!IIlIW!!'" <br /> <br />-;:;"nI?I~ h ~Il <br />Y I fiJ I Fee Current I Y I N <br /> <br />Y I N I Fee Current <br /> <br />Y/N <br /> <br />Y I N I Fee Current <br /> <br />Y/N <br /> <br />Y I N I Fee Current <br /> <br />Y/N <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 />