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<br />813-780-0020 <br /> <br />Date Received <br />-- <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 /> <br />Fax-813-78o-0021 <br /> <br /> <br />/&/3 11~4tjIJq3SI <br />rL 33570 <br />II <br /> <br />-HOR. II <br />'POTOf1:/t C f1;1/?1( <br /> <br />Owner's Phone Number <br /> <br />~(j~KIN <br /> <br />~L <br />I <br /> <br />Titleholder Phone Number I <br /> <br />II <br /> <br />Fee Simple Titleholder Name <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />;, 'IT Im'm r <br /> <br />~itiII , ~f'lil~$$lmml~~~~"":.')'.""'.m.,,~ <br /> <br />lW/J I ~~;~ "'I I <br /> <br />- =- <br /> <br />7tJM/LY <br /> <br />e:,-RJ LL <br /> <br />s -s'-f8 <br />I <br /> <br />GfJLL <br /> <br />Parcel # <br /> <br />t Uti I AII\lt:.U ""~UIVI I""~UI""t:.~ I Y I AA I\lU II,-t:) <br />~Ii t:'l :fI"ll'iTii'lm~;~~~ <br /> <br />- ffn m <br /> <br />"VI <br /> <br />~_~~~,~~~t.i'~1iS:~~'olI~"..,.d';~~"l- <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 />D Standpipes (Sprinkler Sys) <br />D Torch Roofing <br />D Waste Tire Storage ANNUAL <br /> <br />o <br />o <br />o <br />o <br />o <br />o <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />~-?l'~ 7 mint ~,,~., 11m,. t <br /> <br />Comm Exhaust Kitchen Hood/Duct <br /> <br />Controlled Bum <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />Sprinkler D <br />Fire Alarm D <br />Hood Clean/Suppression .~ <br />Fire Alarm Installation <br />Fire Pumps <br /> <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks J <br />Other: ICOHPL:crr EXltffU t:;T SY5TE-f/} <br /> <br />I Valuation of Project <br />C t:-:etJ IJ IN C; <br /> <br />IMII- <br /> <br />-'!JIOa , <br />Company I <br />Registered <br />License # I <br />Company I <br />Registered <br />License # I <br />Company I <br />Registered <br />License # I <br />Company I <br />Registered <br />License # I <br />Company I <br />Registered <br /> <br />fiilimr <br /> <br />IlHf);.,=--,......~ <br /> <br />ii~t <br /> <br />Fee Current <br /> <br />Contractor <br />Signature <br /> <br />Address I <br /> <br />ELECTRICIAN <br />Signature I <br /> <br />Address I <br /> <br />PLUMBER <br /> <br />Signature <br /> <br />Address I <br /> <br />MECHANICALj <br />Signature . <br /> <br />Address I <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />~/7 <br /> <br />I <br />I <br />I <br /> <br /> <br />"._~_,= "='''.'~_a.,l <br /> <br />t j""",,";,u""0:-:a.'>;-';-"'''''''''''' .,..;t-tll:)$'~H~"i:;.fiif'l::w.';c;""""""", <br /> <br />I <br />";;';:j"-~~~m~~l~ <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />OTHER <br />Signature <br /> <br />I~ <br /> <br />l"""""'"" Addr~;;,J,,,., <br />Directions: <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />License # I <br />.ll~~..1 ..Y. <br /> <br />~.=;;,~'i>i;""';..o:;;;';;;;';';..;"""""':l'-:''''''''''''O:;:.<''~''''''";;;,;;,:",."..;,;"',......, <br /> <br />=,,,,,.-<;>X.;>.--.'.,;.~~.'m <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 />