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<br />813-780-0020 <br /> <br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />Fee Simple Titleholder Name <br /> <br />~ 1 3<f<.f <br /> <br />Fax-813-780-0021 <br /> <br />City of Zephyrhills Fire <br />Permit Application <br /> <br />Phone Contact for Permit <br /> <br /> <br />CiJ...Ut3 of 2EPH'lII2J..1ILLSI Owner's Phone Number <br />11~~'-- /-E fl-l Y"- f-J l ,-LS r J,., <br />I Titleholder Phone Number <br /> <br /> <br />J....1o~1 <br /> <br />, /S' <br />51.~ II 7J:.? <br />33S4~ <br />I II <br /> <br />I J;to~ '/-1 <br /> <br />: <br /> <br />I <br /> <br />II <br /> <br />...l=~~lft~~ <br /> <br />Fee Simple Titleholder Address <br /> <br />~....8ill!umlW <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />I$~/~ <br />I <br /> <br />1 J!: 'St <br /> <br />I Lot# <br /> <br />Parcel # <br /> <br />{UtsIAINt:U I-KUM I-'KUt-'t:KI Y I~,:~:)_ <br /> <br />D Bio-Hazard Waste Storage - ANNUAL <br />D Comm Exhaust Kitchen HoodlDuct <br />D Controlled Bum <br />D Emergency Generator < 30 kw <br />D Emergency Generator> 30 kw <br />D Fire Protection Maintenance - ANNUAL <br />Sprinkler 0 <br />Fire Alarm 0 <br />Hood Clean/Suppression 0 <br />Fire Alarm Installation <br /> <br />D <br />D <br />D <br />o <br />o <br />D <br />C~ntractor ! <br />Signature . <br />Address <br />ELECTRICIANI <br />Signature <br />Address I <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANICAL! <br />Signature . <br /> <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />Address <br /> <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />D <br />D <br />D <br />D <br />D <br />[81 <br />D <br />D <br />D <br />D <br />D <br />o <br /> <br />Fumigation Tent <br />Hazardous Material (Tier II or RQ Facility) ANNUAL <br />Hood Installation <br />LP/Natural Gas-Installation <br />LP/Natural Gas-ANNUAL Sale <br />Places of Assembly-ANNUAL <br />Recreational Bum <br /> <br />Sparklers <br />Sprinkler System Installations <br />Standpipes (Sprinkler Sys) <br />Torch Roofing <br />Waste Tire Storage ANNUAL <br /> <br />Valuation of Project <br /> <br />Other: <br /> <br />-/e;ruj~ <br /> <br />~ <br /> <br />Company <br />Registered <br /> <br />~(~ui~ <br />I I <br /> <br />I Y / N I Fee Current Y / N I <br />I I <br /> <br />I Y / N I Fee Current Y / N I <br />I <br /> <br />Y / N I Fee Current Y / N I <br />I <br /> <br />Y / N I Fee Current Y / N I <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />Directions: <br /> <br />License # <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 />