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<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 />17"..........,.,'"'''''''''' <br /> <br />Fee Simple Titleholder Name <br /> <br />&~~~L"," I,~.~.:~~:~=L", I film' "_ .,,~,,'" <br />lA-FieNe IIf-Cf!Jt5 <br />I ZC;3~ We;f"FCJ~ ~~6EN <br />I <br />I <br /> <br />~im=~~ ~mam:~"'\j/.,~~ >ll ~ <br /> <br />176'1; 3 IflrLL 6LI/: <br />I <br /> <br />Fax-813-780-0021 <br /> <br />Phone Contact for Permit <br />~I#UJ.._ ~ h.~ ~. <br /> <br />J ,_,_::JL.__JJ" <br />I II II <br /> <br />?1'i'fY'~"~,'''''''''': <br /> <br />Owner's Phone Number <br /> <br />I Titleholder Phone Number <br /> <br />II <br /> <br />II <br /> <br />Fee Simple Titleholder Address <br /> <br />- <br /> <br />-- <br /> <br />~~D't'ii <br /> <br />~ "'" <br /> <br />7""- ...~'---""'!il:m~~_~1Ii; <br /> <br />I Lot# <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />...W"'-Ak;""",,,, <br /> <br />....A~~=: <br /> <br />n17f <br /> <br />m~~~,~'--r:l>.lI <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br /> <br />D <br />o <br />D <br />D <br />o <br />o <br />o <br />D <br />D <br />o <br />~ <br />o <br /> <br />D <br />D <br />D <br />D <br />D <br />~ <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />..... 7'O!ir;- <br /> Company I <br /> Registered <br /> License # I <br /> Company J <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 /> <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 />~~~-m~1 v IJ:' <br /> <br />Other: <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 />MECHANICALI <br />Signature . <br /> <br />Address <br /> <br />OTHER -Jf <br />Signature <br /> <br />Address <br /> <br />Directions: <br /> <br /> <br />~,~;Bi:X:~W_"-"'."Vi-_'- N.<---_,.""".,...._.,.-,",','.,_;.;;;~.-,~:"""_-:',-... <br /> <br />Parcel # <br /> <br />tUb I AII'III:.U r-KUIVI t"'KUt"'I:.K 1 Y I f\A I'IIU 11\"'1:.) <br />'q Jl _rliJ!il!l~~._____ :JlR"Ti~~rYfril':~""'~!!'~! <br /> <br />t1~- <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 /> <br />Recreational Bum <br /> <br /> <br />--- <br /> <br />flOl <br />Sparklers U ~ \ n <br /> <br />Sprinkler System Installations P! rn <br /> <br />~6~. ~, <br />1\ 'a-s'/O. ~ <br />Waste Tire Storage ANNUAL f () /.... ........ _ arv,...... J- ~ <br />lz ZO - \~ ('-"--'VC-J-{ ll~uu. <br />~Gn~ -h::>"T~ ~ <br />I r"}. bOO. <!!2- I Valuation fdf Project <br />rvu.d -+-0 ~~ <br /> <br />.~ <br /> <br />Standpipes (Sprinkler Sys) <br /> <br />Torch Roofing <br /> <br />= <br /> <br />1W'1'<1'~'~~"W""V <br /> <br />"I!lll!'ll <br /> <br />Y/N <br /> <br />Y I N Fee Current <br /> <br />Y/N <br /> <br />Y I N Fee Current <br /> <br />Y I N Fee Current <br /> <br />Y/N <br /> <br />Y I N I.. Fee Current <br /> <br />Y/N <br /> <br />Y I N Fee Current <br /> <br />Y I N I <br /> <br />License # I I <br />Llmt~",~, ~-"'$.'''''~''::''<WU>~~i<;-'''''''','''''''''''''''~~''''~~~~~~~~ <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 />