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<br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />813-780-0020 <br /> <br />1\- I y-O <br /> <br /> <br />Phone Contact for Permit <br /> <br />/rt.\\u"'O T~l _.:S-~ <br />Il~ ~9 GtQ\ I '"bll)d <br />I <br />I <br /> <br />Fee Simple Titleholder Name <br /> <br />Fee Simple Titleholder Address <br /> <br />City of Zephyr hills Fire <br />Permit Application <br /> <br />Ho~s <br /> <br />Fax-813-780-0021 <br /> <br /> <br />I ~J3 <br /> <br />Owner's Phone Number <br /> <br />I Titleholder Phone Number I <br /> <br />Parcel # <br /> <br />1/ <br /> <br />/I <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />~o..rnL <br /> <br />I Lot# <br /> <br />(Vl:S I AII'It:U t-KVIVI ~KV~t:K J Y I f\A I'IV 11~t:) <br /> <br />D <br />D <br />D <br />D <br />D <br />~ <br /> <br />o <br />o <br />D <br />o <br />o <br />o <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br />Comm Exhaust Kitchen Hood/Duct <br />Controlled Bum <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />Sprinkler D <br />Fire Alarm ~ <br />Hood Clean/Suppression D <br />Fire Alarm Installation <br /> <br />Fire Pumps <br /> <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <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 />Valuation of Project <br /> <br />Other: <br /> <br /> <br />Contractor <br />Signature <br /> <br />Address: .~~IICj <br /> <br />ELECTRICIAN <br />Signature <br /> <br />Address I <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br />Signature . <br /> <br />Address I <br /> <br />OTHER <br />Signature <br /> <br /> <br />Dod~(/I-J <br /> <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 ~ ~t.jQIN.. ~tittn 1(. ~ S~ <br />. ~ I Pee Current I Y7N I <br /> <br />I f:+ - OOOI6~lo I <br /> <br />I Y / N , Fee Current Y / N , <br /> <br />I I <br /> <br /> <br />I Y / N I Fee Current <br /> <br />I <br /> <br /> <br />I Y I N I Fee Current <br /> <br />I <br /> <br />I Y I N I Fee Current <br /> <br />Y/N <br /> <br />Y/N <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 />