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<br />Specialt~ Electronic S~st
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<br />P.2~
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<br />Fax-B13-780-0021 ~
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<br />Dec 20 07 03:43p
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<br />City of.Zephyrhills Fire
<br />Permit Application
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<br />813-780~OD20
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<br />Owner's Name
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<br />Owner's Address
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<br />Fee Simple Titleholder Name
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<br />352-521-6085
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<br />I Titleholder Phone Number I
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<br />If
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<br />II
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<br />Fee Simple Titleholder Address
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<br />Job Address [,(p B Ib r;.'Jr II 8 /1/ ~I I Lot # f
<br />I Parcel # I
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<br />D 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 Sate
<br />D Places of Assembly-ANNUAL
<br />D Recreational Bum
<br />D Sparklers
<br />D Sprinkler System Installations
<br />D Standpipes (Sprinkler Sys)
<br />o Torch Roofing
<br />D Waste Tire Storage ANNUAL
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<br />Sub Division
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<br />D
<br />D
<br />D
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<br />D
<br />D
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<br />D
<br />D
<br />D
<br />D
<br />D
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<br />Bic-Hazard Waste Storage - ANNUAL
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<br />Comm Exhaust Kitchen Hood/Duct
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<br />Controlled Bum
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<br />Emergency Generator < 30 kw
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<br />Emergency Generator> 30 kw
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<br />Fire Protection Maintenance - ANNUAl.
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<br />Sprinkler
<br />
<br />D
<br />[0'
<br />D
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<br />Fire Alarm
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<br />Hood Clean/Suppression
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<br />Fire Alarm Installation
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<br />Fire Pumps
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<br />Fire Works
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<br />Flammable Application- ANNUAL
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<br />J fp tJCJD UV
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<br />Valuation of Project
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<br />Fuel Tanks
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<br />Other:
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<br />Address I
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<br />Contractor
<br />Signature
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<br />Address I
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<br />ELECTRICIAN
<br />Signature I
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<br />Address I
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<br />PLUMBER
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<br />Signature
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<br />Address I
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<br />~ECHANICALI
<br />Signature .
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<br />Address I
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<br />I ~:;:~~~d I Y I N
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<br />I License iI I
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<br />I ~:;~:~d I Y J N
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<br />I License # I
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<br />1 ~:::~~~d I Y I N
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<br />I License #1
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<br />I ~:;:~~~d I Y I N I' Fee Current
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<br />I License # I
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<br />I ~:;:~~~d I y-7rff~ Fee Current Y I NI
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<br />Fee Current
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<br />Y/N
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<br />YJN
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<br />Fee Current
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<br />Y/N
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<br />Fee Current
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<br />Y/N
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<br />Fill out application completely.
<br />Owner & Contractor sign back. of application. 'notarized (Or, copy oi 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.
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