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<br />813-780-0020 <br /> <br />. <br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br /> <br />City of.Zephyrhills Fire <br />Permit Application <br /> <br />Phone Contact for Permit <br /> <br />~j.2(; "7 <br /> <br />f1~/ <br />Gfflll5(~ <br />r <br /> <br /> <br />Fee Simple Titleholder Name <br /> <br />Fax-813-780-0021 <br /> <br />Owner's Phone Number <br /> <br /> <br />",'0 <br /> <br />~{3 II <br /> <br />Titleholder Phone Number I <br /> <br />II <br /> <br />II <br /> <br />m-TirrrarrITr nr.1J <br /> <br />m.T1I'i:mr <br /> <br />~"""'" 111 1 ~ <br /> <br />Fee Simpie Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />\!Ii""'" <br /> <br />o <br />o <br />D <br />o <br />o <br />o <br /> <br />~m <br /> <br />~z-V(J' <br /> <br />&t?- (/ <br /> <br />Alv~ <br />I <br /> <br />r- <br /> <br />om <br /> <br />D Fire Alarm Installation <br />D Fire Pumps <br />D Fire Works <br />D Flammable Application- ANNUAL <br />D Fuel Tanks <br />o Other: I <br /> <br />~~:.:' ! /(/ / fk. _) ~ 1'n~12 <br /> <br />Address . <br /> <br />ELECTRICIAN <br />Signature I <br /> <br />Address I <br /> <br />PLUMBER I <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br />Comm Exhaust Kitchen HoodlDuct <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />~ <br />I <br /> <br />Controlled Bum <br /> <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br /> <br />Sprinkler <br /> <br />D <br />D <br />D <br /> <br />Fire Alarm <br /> <br />Hood Clean/Suppression <br /> <br />2~'l~~" 115 ?/ J7>~Y/ Lot# <br /> <br /> <br />Parcel # I ' <br />t Uti I AINCU t"KUIVI ,...KU,...CK I Y I fV\ I'IIU /1\"'1::) <br />-J:'~ - <br /> <br />-1 <br /> <br />Fumigation Tent <br />Hazardous Material (Tier II or RQ Facility) ANNUAL <br />Hood Installation <br />LP/Natural Gas-Installation <br /> <br />LP/Natural Gas-ANNUAL Sale <br />Places of Assembly-ANNUAL <br />Recreational Bum <br /> <br />12~-uo..O - a~ rvx~ <br />Up -tv 3 (X) . <br />+( ~.J.::S <br /> <br />Sparklers <br /> <br />--- <br />Sprinkler System Installations <t-~ ~ _ -a..:.:> 5S""" ' '005'] <br />Standpipes (Sprinkler Sys)__ ili. ~ <br />Torch Roofing ~~ LL.c...... <br />Waste Tire Storage ANNUAL Po c:? ax. \ ~D(." <br />jOe-I ho.rn ~ <br />Valuation of Proj~ct '35 12.l..( <br /> <br />Signature <br /> <br />Address I <br /> <br />~ECHANICALI <br />Signature <br /> <br />Address I <br /> <br />OTHER <br /> <br />~.-.- '-;C-l'X'" <br /> <br />I <br />I <br />.,~- , <br /> <br />Signature <br /> <br />Address .L.,,,., <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 /> <br />u " ~ <br /> <br />lilIl) <br /> <br />Company <br />Registered <br /> <br />1:1 Q P"S Pi uc;. <br />I Y I N I Fee Current <br />I <br /> <br />I Y I N I Fee Current I <br /> <br />I <br /> <br />I Y I N I Fee Current I <br />I <br /> <br />I Y I N I Fee Current <br />J <br /> <br />I Y/N <br />j <br /> <br />..... <br /> <br />Y/N <br /> <br />I <br />I <br />I <br />I <br />I <br />I <br />, <br />I <br />I <br />L.._..~, <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Company <br />Registered <br /> <br />Y/N <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Company <br />Registered <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />License # <br /> <br />~.,~ <br /> <br />. ~"-'-. <br /> <br />...I!>z.o;='.,.><..........._'.:.~"'= <br />