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<br />813-780-0020 <br /> <br />Date Received <br /> <br />OWner's Name <br /> <br />OWner's Address <br /> <br />City of Zephyrhills Fire <br />Permit Application <br /> <br />Phone Contact for Permit <br /> <br />Fax-813-780-0021 <br /> <br />,We' .,... or D. _. . <br /> <br />117%2 II FrS? <br /> <br />I <br />I g() <br /> <br />1/~-/--0'7 <br />I vVC4/- M Gl ~ t- <br />17&S I r: q// <br /> <br />, <br /> <br />I <br />I <br /> <br />.::J:NL. <br />/3/uJ <br /> <br />I OWner's Phone Number <br />2r'(7ht,k,\\~ re!- <br /> <br />I Titleholder Phone Number 181 ~ <br /> <br />IIZf~ 111157 <br /> <br />Fee Simple Titleholder Name <br /> <br />Fee Simple Titleholder Address <br /> <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />o <br />o <br />o <br />D <br />D <br />[I] <br /> <br />D <br />D <br />D <br />D <br />D <br />o <br /> <br />Contractor <br />Signature <br /> <br />Address <br /> <br />ELECTRICIAN <br />Signature <br /> <br />Address I <br /> <br />I <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANIC4 <br />Signature <br /> <br />Address I <br /> <br />7bA / ~~ l!.~ <br /> <br />I Parcel # <br /> <br />~"if1- <br /> <br />I Lot# <br /> <br />\UtlIA/I'IIeU r-KUM t""Kut""eKI T I fV. NU IIL.e) <br />-b.. __ ..L~1%:~< <br /> <br />Bio-Hazard Waste Storage - ANNUAL 0 Fumigation Tent <br />Comm Exhaust Kitchen HoodlDuct 0 Hazardous Material <br />Controlled Bum 0 Hoocllnstallation <br />Emergency Generator < 30 kw 0 LP/Natural Gas-Installation <br />Emergency Generator> 30 kw 0 LP/Natural Gas-ANNUAL ale <br />Fire Protection Maintenance - ANNI:IAL tif..vll /l1F- ~ 0 Places of Assembly-ANNU <br />Sprinkler 1%L -- 0 Recreational Bum <br />Fire Alarm 0 0 Sparklers <br />Hood Clean/Suppression 0 0 Sprinkler System Installations <br />Fire Alarm Installation 0 Standpipes (Sprinkler Sys) <br />Fire Pumps 0 Torch Roofing <br />Fire Works 0 Waste Tire Storage <br /> <br /> <br />Flammable Application- ANNUAL <br />Fuel Tanks <br />Other: <br /> Company <br /> Registered <br /> Ucense # I <br /> Company I <br /> Registered <br /> I License # I <br /> I Company I <br /> Registered <br /> I License # I <br /> I Company r <br /> Registered <br /> I Ucense # I <br /> I Company I <br /> Registered <br /> ~ Ucense # I <br /> <br /> <br />Fee Current <br /> <br /> <br />I <br /> <br />Y IN I <br />I <br /> <br />Y I N I <br />I <br /> <br />Y I N I <br />I <br /> <br />Y IN I <br />." J <br /> <br />__~".....L.~J':;" <br /> <br />Y I N I Fee Current I <br /> <br />Y I N I Fee Current I <br /> <br />OTHER <br />Signature <br /> <br />Address I <br /> <br />Directions: <br /> <br />Y I N I Fee Current , <br /> <br />Y I N I Fee Current <br /> <br />,-. ~"'... <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 />