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<br />813-780-0020 <br /> <br />Date Received <br />%ri. <br /> <br />OWner's Name <br /> <br />Owner's Address <br /> <br /> <br />City of.Zephyrhills Fire <br />Permit Application <br /> <br />Phone Contact for Permit <br /> <br />li?4 ~2L 0 fJORlJf1t-fl I <br />rOTOf1TJC !1TJf<C PL <br />I <br /> <br />Fee Simple Titleholder Name <br /> <br />~lln~lIir <br /> <br />;ijnm~d~;{~P'Vn"'V"'~~~ <br /> <br />r~~t <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />Fax-813-780-0021 <br /> <br />Owner's Phone Number <br /> <br />'L_,__-1L..~,.....~.l-L,__,,_, <br /> <br />/g/3 /IsLfs-I/13S-1 <br />33570 <br />I II <br /> <br />7(f/SK/;V ti <br /> <br />II <br /> <br />Titleholder Phone Number <br /> <br />s fig 6:1LL :eL.I//) <br />I <br /> <br />ill~12Jm~~~.m~~R':"~j'r;,w~'f.i~ <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br /> <br />D <br />o <br />D <br />D <br />D <br />o <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />~~~".~ ~rfl':~'W~~ <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 0 <br />Hood Clean/Suppression rzr <br />Fire Alarm Installation <br /> <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />(',>\, \ ' <br />, :: .'-.. \ <br /> <br />I Lot# <br /> <br />Parcel # <br /> <br />1\~1 <br /> <br />tUb U\II'\1l:.U r-KUIVI r-'KUr-'l:.K I Y I fV. I'\IU 11~l:.) <br />WIA ,.~.~~ 4-~\~~~_~~~i""""""~~ <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 />Other: <br /> <br />ICOt1f'L-c FE <br /> <br />I <br />-EKi171 US7 SYSTEM <br /> <br />Valuation of Project <br />C;~/V11J0' <br /> <br />Fuel Tanks <br /> <br />"/ -q', l' <br /> <br />Contractor <br />Signature <br />Address I <br />ELECTRICIAN <br />Signature I <br />Address I <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br />Signature <br /> <br />Address I <br /> <br />I <br />I <br />~~~~~re ~ k4 I <br /> <br /> <br />~dres.~.J",,,,;,,,,,,,,,.=";,,.,,~, ,., ,,"..,.;,,,_;,,,,,,,,,,,,,,,~,~=,";,,,,,=>_,,__. ."""-,,",,=,,._M1. <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 i :f1 <br /> <br />_:.. <br /> <br />~ <br /> <br />'iH <br /> <br />S!ti <br /> <br />Company I <br />Registered <br /> <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />Y IN I <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />~i;;"~~.l.";=";=_",",,,,"..m;'="'~";;"='~";"'," ;""'""_~""~ <br />