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<br />813-780-0020 <br /> <br />D<:fte Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />Fee Simple Titleholder Name <br /> <br /> <br />City of Zephyr hills Fire <br />Permit Application <br />I'['t ,. ,,_ ,-~\~t <br />, S( I" I Phone Contact for Permit <br /> <br />Fax-813-780-0021 <br /> <br /> <br />i,. \ "\.....>..A.l.- <br />a.- -0 '.\'\) <br /> <br />\0:::" ::Q:~ (~,".rh <br />I <br />I <br />;~; <br /> <br />L.{.-\-y\ Au.P ~ <br /> <br />II n 0.-\ J ~~C04-1 <br />I III'I!I <br />, TOehold" Phooe Numbe' . . . . . <br /> <br /> <br />" ! ._._.__.~r"~m T" ! <br /> <br />I Lot# I <br /> <br />\ l~tj ,iiN~~t-i<LM ~~~~~~ I ~ i~(~~, ~~~J~\ '~~ <br />f)Q" t\"U. ~\s 'ne <br />'1'% <;$:-~ (0(023% <br /> <br />I Owner's Phone Number <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />D <br />D <br />D <br />D <br />o <br />o <br /> <br />D <br />D <br />o <br />o <br />o <br />D <br />I <br /> <br />Contractor <br />Signature <br />Address I <br />ELECTRICIANI <br />Signature <br />Address I <br /> <br />PLUMBER <br /> <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br />Signature <br /> <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />Parcel # <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br />Comm Exhaust Kitchen Hood/Duct <br />Controlled Bum <br /> <br />o Fumigation Tent <br /> <br />o <br />o Hood Installation <br />o LP/Natural Gas-Installation <br />o LP/Natural Gas-ANNUAL Sale <br />~ Places of Assembly-ANNUAL <br />0- 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 />Hazardous Material (Tier 1\ or RQ Facility) ANNUAL <br /> <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br /> <br />Sprinkler <br />Fire Alarm <br /> <br />o <br />o <br />o <br /> <br />Hood Clean/Suppression <br />Fire Alarm Installation <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL. <br /> <br /> I <br />I Company I <br />Registered <br />I License # I <br />I Company I <br />Registered <br />I License # I <br />I Company I <br />Registered <br />I License # I <br />I Company I <br />Registered <br />I License # I <br />I Company I <br />Registered <br /> License # <br /> <br />Fee Current <br /> <br />Valuation of Project <br /> <br />Fuel Tanks <br /> <br />Other: <br /> <br />~1iiiW- <br /> <br />I <br /> <br />ili\I&kM{ <br /> <br />I <br /> <br />Fee Current <br /> <br />Y I N I <br />I <br /> <br />I <br />I <br /> <br />I <br />I <br /> <br />I <br />I <br /> <br />I <br /> <br />Y IN I <br /> <br />Y IN I <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y IN I <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Fee Current <br /> <br />Y/N I <br /> <br />Y/N <br /> <br />~i<~~i~- <br /> <br />/;/M~ <br /> <br />Y IN I <br /> <br />Y/N <br /> <br />Address <br /> <br />Directions: <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 />