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<br />813-780-0020 <br /> <br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />Fax-813-780-0021 <br /> <br />City of.Zephyrhills Fire <br />,Permit Application <br /> <br />Phone Contact for Permit <br /> <br /> <br /> <br />Owner's Phone Number <br /> <br />~13 <br /> <br />II'II~I,~ <br /> <br />Fee Simple Titleholder Name <br /> <br />"i - _"~:f0 .~- <br />5:32.) ',\)6\ \f' <br /> <br />I J\ DC. r'l J)e,~ '(hI- u<:>",~,'i('e' PI"ne Numbe' I i5 n <br />, <-..h. "" Q'I>,) .:16 <br />I (~ \ D I S. \ v~~ "'r.le.. . 1 <br /> <br />L 7 G-~\\ <br /> <br />Fee Simple Titleholder Address <br /> <br />::::~::-.>~ i'.~'5 3 <br /> <br />Sub Division <br /> <br />~~1Wlf <br /> <br />_----A~~ l~~ _ <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 />Contractor <br />Signature <br /> <br />Address I <br /> <br />ELECTRICIAN <br />Signature I <br /> <br />Address I <br /> <br />PLUMBEE <br /> <br />Signature <br /> <br />Address I <br /> <br />MECHANICALj <br />Signature ' I <br /> <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />o Fumigation Tent <br />o Hazardous Material (Tier II or RQ Facility) ANNUAL <br />o Hood Installation <br />o LP/Natural Gas-Installation <br />DY/Natura, Gas-ANNUAL Sale <br />~Iaces of Assembly-ANNUAL <br />o Recreational Bum <br />o Sparklers <br />o Sprinkler System Installations <br />o Standpipes (Sprinkler Sys) <br />o Torch Roofing <br />o Waste Tire Storage ANNUAL <br /> <br />I <br /> <br />~\\J 0 <br />I <br /> <br />Parcel # <br /> <br />Bic-Hazard Waste Storage - ANNUAL <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 D <br />Fire Alarm Installation <br />Fire Pumps <br /> <br />Fire Works <br />Flammable Application- ANNUAL <br /> <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 />License # <br /> <br />Company <br />Registered <br /> <br />-~ <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />------ <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />-..... <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />----., <br /> <br />...."''";>.,''',.,... <br /> <br />'" "''''''.'''~~''~'''~-i'f ......' '..;0'''''''''' ..=- ....'. <br /> <br />,""",' ,,,.,~ '_'W"'~,~~'" ,>,.<, <br /> <br />'_~'"~"_Fj <br /> <br />License # ',), <br />.~ - <br /> <br />!~~~~ II :Ib~ <br /> <br />I Lot# I <br /> <br />I <br /> <br />\ Vb I AII'Il~~ r-t'(VIVI t"'~vt"'t:t'( I Y I ~~~~~~:J <br />17 r-r d -IW!liWl:'V-"'''- ~a <br /> <br /> <br />,,/ "---' <br /> <br />.-111~~~ <br /> <br />~ <br /> <br />I <br /> <br />Valuation of Project <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />~. ,._._'.""_,'__..,"~~_="~,_~=~~>~ ,__'=_ L~o.._~'" <br /> <br />,....._ Address L ",".., <br /> <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 />