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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 /> <br />* 13~~ <br /> <br />Fax-813-780-0021 <br /> <br /> <br />Phone Contact for Penn it <br /> <br />I Owner's Phone Number I 2' I '3 II 71 01 IS-I/ I <br />y-~~k.. /i-/7Zt/e.. ~J 3.70'/-6/,64' I <br />, <br /> <br />I Titleholder Phone Number I T I J - II 71 $-1 J / S7 / I <br />/?t:JX' /~/,7 7T~/ ~ ;;r.:;:;,;?e,,~ , ~t ..:l"~r)'-<6?6J1 <br /> <br />I L(.,tfJ~r1 <br />I P..~.JI!5f/X /b7~R <br />I <br />lr~, <br /> <br />I SI:lO G-all /?/vd. <br />I <br /> <br />Fee Simple Titleholder Name <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />Ze"l.y,.l.;t!.s IF! :r "1 rI^- I Lot# <br />... ... <br /> <br />Parcel # 111-2'''.lI-~D/~ "07d?tJt1'-~/;t. <br />(Uti I AINt:U I-KUM t-'KUt-'t:K I Y I AX NU 11l;t:) <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />D Fumigation Tent <br />D Hazardous Material (Tier II or RQ Facility) ANNUAL <br />D Hood Installation <br />D LP/Natural Gas-Installation <br />D LP/Natural Gas-ANNUAL Sale <br />D Places of Assembly-ANNUAL <br />D Recreational Bum <br />D Sparklers <br />D Sprinkler System Installations <br />D Standpipes (Sprinkler Sys) <br />D Torch Roofing <br />D Waste Tire Storage ANNUAL <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br />Comm Exhaust Kitchen HoodlDuct <br />Controlled Bum <br /> <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br /> <br />Sprinkler <br />Fire Alann <br />Hood Clean/Suppression <br />Fire Alann Installation <br /> <br />D <br />~ <br /> <br />Fuel Tanks <br /> <br />&~ I Valuation of Project <br /> <br />Company <br />Registered <br />License # <br /> <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Other: <br /> <br />Contractor <br />Signature <br /> <br />Address I <br /> <br />ELECTRICIANI <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 />OTHER <br />Signature <br /> <br />I <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Address <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />I ~'~T ~~~~~1~. <br /> <br />ls'1J~~2D4:JC)/~.Y' I <br /> <br />Y I N I Fee Current Y I N I <br />I <br /> <br />Y I N I Fee Current <br /> <br />Y/N <br /> <br />, Y I N I Fee Current <br /> <br />Y/N <br /> <br />Y I N I Fee Current <br /> <br />Y/N <br /> <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 />