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<br />813-780-0020 <br />. <br /> <br />Date Received <br />a~~ <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 /> <br />Fee Simple Titleholder Name <br /> <br />~t~~~~"POO"eNumbe' <br />I <br />I <br />~-~~~1-'~~303 }/o&tLltV~ <br />I <br /> <br />~ <br /> <br />.~,;\,~,~ <br /> <br />.li:IHT~;1~~~.JfI1~-""'''' <br /> <br /> <br />I Lot# <br /> <br />i~ <br /> <br />Fee Simple Titleholder Address <br /> <br />Sub Division <br /> <br /> <br />Phone Contact for Penn it <br /> <br />I~~ <br />i I II <br /> <br />liI?> <br /> <br />I Titleholder Phone Number I <br /> <br />--1fT <br /> <br />..- <br /> <br />_~_~r-,a.'-,,"_ <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br /> <br />o <br />o <br />o <br />o <br />o <br />~ <br /> <br />o <br />D <br />D <br />D <br />D <br />D <br /> <br />'~~~~,~-i~!r"'- - <br /> <br />Contractor <br />Signature <br /> <br />Address I <br /> <br />ELECTRICIAN <br />Signature I <br /> <br />Address I <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANICAL <br />Signature <br /> <br />Comm Exhaust Kitchen HoodlDuct <br /> <br />Controlled Bum <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />Sprinkler D <br />Fire Alann [iZJ <br />Hood Clean/Suppression D <br />Fire Alann Installation <br /> <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />Parcel # <br /> <br />~Ut) I AII'IIt:LJ r-"UIVI t"'''Ut'''t:'' I r I fV\ I'IIU 11\..t:) <br />_...4l.::.IMl~ ~~~~~1Jh~ <br /> <br />IT-il'''--\WI(J'1 <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 />o LP/Natural Gas-ANNUAL Sale <br />o Places 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 />Valuation of Project <br /> <br />Other: <br /> <br />.... <br /> <br />tPW <br /> <br />.t1rr- ~.Il <br /> <br />~ <br /> <br />~Wl'~ <br /> <br />If <br /> <br />-n> <br /> <br />I <br />~~~~,~~__.._.._~1. <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 /> <br />Company I <br />Registered Y I N <br /> <br />License # I <br /> <br />Company I <br />Registered Y I N <br /> <br />License # I <br /> <br /> <br />I Y/N <br /> <br />License # I <br /> <br />Company I <br />Registered Y I N I Fee Current <br /> <br />License # I &: ~ OCJO 10(/ b <br /> <br />Company I c;' c" 5 <br />Registered Y I N I Fee Current Y I N <br /> <br />Licer:.:: # """",L,..."",~*~_""", ~"" ".,,""'''''_~='''''_- <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Company <br />Registered <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br />