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<br />813-780-0020 <br /> <br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />City of.Zephyrhills Fire <br />. Permit Application <br /> <br />Phone Contact for Permit <br /> <br />-t,,~ Z:.. <br /> <br />~ \-. ..)0- .'~ l <br /> <br /> <br />.,rl' <br /> <br />, /---(; <br />I TO'Nt-N \6""" A.6-rA\l.. L..\wG <br />i7~~ ~oNswa<'~6NsrA..(E Roo <br />I <br />I <br /> <br />I I ~O(o (..,Ac"t- <br />I <br /> <br />Fee Simple Titleholder Name <br /> <br />Owners Phone Number <br /> <br />~l.A ~YNw'(o;pA.,. <br />I Titleholder Phone Number I <br /> <br />J1~ 100:) <br />Fax-813-780-0021 <br /> <br /> <br />J~3~-U~!d <br />II. to! <br />\~OO~lD"t. <br />IIIL <br /> <br />- <br /> <br />Fee Simple TItleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />mw--- <br /> <br />o <br />o <br />o <br />o <br />o <br />D <br /> <br />o <br />o <br />o <br />o <br />o <br />o <br /> <br />L_ <br /> <br />Contractor <br />Signature <br />Address I <br /> <br />ELECTRICIAN <br />Signature I <br /> <br />Address I <br /> <br />] <br /> <br />PLUMBER <br />Signature . <br /> <br />Address I <br /> <br />MECHANICALI <br />Signature . <br /> <br />Address I <br /> <br />Bf-" 0 <br />I <br /> <br />,Bio-Hazard Waste Storage - ANNUAL <br />Comm Exhaust Kitchen HoocllDuct <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 /> <br />Fire Pumps <br />Fire Works <br />Flammable Applicatlon- ANNUAL <br />Fuel Tanks <br /> <br />Other: <br /> <br />.1 Lot# <br /> <br />c <br /> <br />Parcel # <br /> <br />l35"~"z..~ -.OO\(). ()~~~,cio'oo <br />tU!) 'leu I"'UIVIl""~Ul"'el"'f\A I'IUllvl;) <br />.dl1 IT <br /> <br /> <br />- <br /> <br />'" ~l -~,. <br /> <br />o Fumigation Tent <br />o Hazardous Material (TIer 11 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 />r:;aJ Sprinkler System InstallatiDns <br />o Standpipes (Sprinkler Sys) <br />o Torch Roofing <br />o Wast~ Tire Storage ANNUAL <br /> <br />11" CnOO. () lJ '.1. Valuation of Project <br /> <br />~ <br /> <br />OTHER <br />Signature <br /> <br />Address <br />~ ~ <br />Directions: <br /> <br /> <br />~ <br /> <br />IC. <br /> <br />Y I N I . Fee Current , VI NI <br />I <br /> <br />Y I N I Fee Current I Y I NI <br />I <br /> <br />Y i N I Fee Current I Y I N I <br />"'1 <br /> <br />Y / NI FeeCufT:Bllt I Y / N I <br />I <br /> <br />Company <br />Registered <br /> <br />License # 'I <br /> <br />Company I <br />Registered <br /> <br />License # I <br /> <br />Company '.1 <br />Registered '. <br /> <br />License # I <br /> <br />Company I <br />Registered <br /> <br />LIcense # I <br /> <br />Company <br />Registered <br /> <br /> <br />License # <br /> <br />Fill out application completely. ' ~ :z <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 />