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<br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />813-780-0020 <br /> <br />City of.Zephyrhills Fire <br />Permit Application <br /> <br />Fax-813-780-0021 <br /> <br /> <br />Phone Contact for Permit <br /> <br />Titleholder Phone Number I <br /> <br />Fee Simple Titleholder Name <br />Fee Simple Titleholder Address <br /> <br />X,';l <br /> <br />~ -~~~J~~~Wl'nTlP' '~~ <br /> <br />Job Address <br /> <br />~~tmm'~!!'w<tkJ."",,'~ """".,.~;V.i~l!.t~lG <br /> <br />Sub Division <br /> <br />I Lot# <br /> <br />3<6t \~ \\v\c~ ~ <br /> <br />Parcel # <br /> <br />\Ut::S I AII'II~U r-t<UIVI t"'t<ut"'~t< I Y I",^ I'IIU IIL.~) <br />n 17.1 !T ~.11"W"'I~~~~ rrr .d.~~ <br /> <br />JIW/""'~I~rr <br /> <br />S_i1'lJ'~i~",,~,~;J~W~\I'l'i-V. -~~~'ii:~i~;;'W't( <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 />~ Places of Assembly-ANNUAL <br />D Recreational Bum <br />D Sparklers <br />o Sprinkler System Installations <br />D Standpipes (Sprinkler Sys) <br />D Torch Roofing <br />D Waste Tire Storage ANNUAL <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />D <br />D <br />D <br />o <br />D <br />D <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 /> <br />Fire Pumps <br /> <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />Valuation of Project <br /> <br />Other: <br /> <br />.. <br /> <br />n lw- <br /> <br />lIIlil!lfil <br /> <br />.JIII r nli P7 <br /> <br />~~mij"1.":'i 1l&!li1Rf'=:ilff IHffrl ~1IllSI>tmllmtl1il):'jJi.?l: <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 />MECHANiCAL) <br />Signature I <br /> <br />Address <br /> <br />OTHER <br />Signature <br />Address <br />Directions: <br /> <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 />License # J <br /> <br />Fee Current <br /> <br />Y IN I <br />I <br />.~ <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 /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Y/N <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 />