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<br />813-780-0020 <br /> <br />Date~ Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />Sub Division <br /> <br />~;mm~lI:tI' ~r' <br /> <br />D <br />D <br />D <br />D <br />D <br />[~r <br /> <br />D <br />D <br />D <br />o <br />D <br />D <br /> <br />~f)_ Imli"'lll' <br /> <br />Contractor <br />Signature <br />Address <br /> <br />ELECTRICIAN <br />Signature <br /> <br />Address I <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br />Signature <br /> <br />Address I <br /> <br />......r........rJ. <br /> <br />Fax-813-780-0021 <br /> <br />City of.Zephyrhills Fire <br />Permit Application <br /> <br /> <br /> <br />, \,:,,' 'I" <br />I'. 1,' <br /> <br /> <br />..-, \'-" '_. ',. \ <br /> <br />Phone Contact for Permit <br /> <br />~/) <br />I Ho,; J ~ E.y e Q;re C Me.-r I Owner's Phone Number <br />I 63)..9 6e;/1 ~/vJ '2~/).p,A,}/~. Pi <br /> <br />Fee Simple Titleholder Name <br />Fee Simple Titleholder Address <br />lliIliii__ -,~~""'" C" <br /> <br />, . <br />Job Address ' '-' . j <br /> <br />I J <br /> <br />II <br /> <br />I <br />~3~~/ <br /> <br />II <br /> <br />'I Titleholder Phone Number I <br /> <br />II <br /> <br />1f,li'i:11lm~""'IfI];lWW~f:;;~1~' <br /> <br />l ' ~.( -~. .x._~>:""_." <br /> <br />I, >,,-.'( \ <br /> <br />Bio-Hazard Waste Storage - ANNUAL <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 0' <br />Fire Alarm 0 <br />Hood Clean/Suppression 0 <br />Fire Alarm Installation <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />Parcel # <br /> <br />,~~7t..,. /. <br />L-Il...\yG f \_- rC Lot # <br />I ," ' '-, }: ' ,:..' " <br />_ ,." . "'.L -. .:.. . -" (,' ..~ <br />t Uti I AII\lt:U t"t'<UIVI t"t'<Ut"t:t'< I Y <br /> <br />r-~ <br /> <br />',_ ,I. <br /> <br />'- {'. <br />1Ar. NUII~t:) <br /> <br />o Fumigation Tent <br />D 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 />Other: <br /> <br />Valuation of Project <br /> <br /> <br />OTHER <br />Signature <br /> <br /> <br />~ Address l.._""~~,_",,,_,__,"__,,____,,_,_ <br />Directions: <br />Fill out application completely. <br />Owner & Contractor. sign back of appiicatio~,~otarized (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 <br />Registered <br /> <br />Y I N I Fee Current <br /> <br />Y/N <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y I N l Fee Current <br /> <br />Y/N <br /> <br />Company <br />Registered <br /> <br />Y I N I <br />I <br /> <br />I <br />I <br /> <br />I <br />I <br /> <br />-- <br /> <br />Y I N Fee Current <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y I N I Fee Current <br /> <br />Y/N <br /> <br />Company <br /> <br />Registered <br /> <br />License # J" <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />~R.l'~- <br /> <br />"''"'''''.....,..'''''''..,..... ..' .'"~.,.~ '~. ......:_.""'-,. <br /> <br />""~ _.-"'~"."'tili'". <br />