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<br />813-78D-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 />Fee Simple Titleholder Name <br /> <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />41).: ( <br />,~~ <br /> <br />Fax-813-78D-0021 <br /> <br />Phone Contact for Permit <br /> <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 />_" J~~:~s:~ <br /> <br />Parcel # <br /> <br />I?~~ 11:275 <br /> <br />Lot # C. <br /> <br />I~~~?~g !~~~I~~Jx~UI M:) <br /> <br />D Fumigation Tent <br />D Hazardous Material (Tier II or RQ Facility) ANNUAL <br />D Hood Installation <br />~Natural Gas-Installation <br />D LP/Natural Gas-ANNUAL Sale <br />D Places of Assembly-ANNUAL <br />o 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 /> <br />I ~) 5 0 0 C" 4 Valuation of Project <br /> <br />Bia-Hazard Waste Storage - ANNUAL <br />Comm Exhaust Kitchen HoodlDuct <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 />Hood Clean/Suppression D <br />Fire Alarm Installation <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />Other: <br /> <br /> <br />'~~ <br />~ n./~" (~~ <br />I \:.I \O"~ 1,.11 <br />" 1'lV ~CY /" <br />.'\ V rJ>~' ()-~ <br />~bWC <br /> <br />I <br /> <br />I <br />ELECTRICIAN I <br />Signature I <br /> <br />~~I ~ <br />PLUMBER 0 ~ f ~~i~ <br />5;goatu.. : ~ /l _ __ <br /> <br />AddreS4 'II -:J 5 (>." 1" ~ ~ '\ l>< - '" · 51< r C ho,f<] <br />MECHANIC <br />Signature <br />Address I I <br /> <br />I <br /> <br />OTHER <br /> <br />Signature <br />_ ~ddress I <br />~~ - -.'~...,.;;".. <br />Directions: <br /> <br />,.. '---""~.' "",~~,,'. <br /> <br />".. <br /> <br />-'~ .-' <br /> <br />I Y IN <br />I <br /> <br />I Y/N <br />I I <br /> <br />IL ~&j 5 r--~ 1 f') lJ ..-r'\ 10 i t') ~ <br />Y I N I Fee Current I Y I N I <br />Ic~c..I'I'1..."Z$Cl I <br /> <br />I Y / N Fee Current Y / N I <br />I I <br /> <br />I Y I N Fee Current I Y I N I <br /> <br /> <br />.1 ~.,"_', ."_~~" ..',,=_." _L..,..",~_~""". <br /> <br />,-,~ <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 />.~ <br /> <br />Contractor <br />Signature <br /> <br />Address I <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Fee Current <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 />