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<br />I <br />City of Zephyrhills Fire <br />Permit ~pplication <br />I <br />: Phone Contact for Permit <br /> <br />>5 3 <br />I [3 L :3 117 9 d- 1 J 35D0l 1 <br />tv G-IfIJ P,lvr/ ,1-ZePhtffh't1/5, FL 3l{.;1q( <br /> <br /> <br />I I Titleholder Phone Number I II <br />I <br /> <br />8": 3-.780-0020 <br /> <br />Date Received <br /> <br />Fax-813-780-0021 -tf1cflV' <br /> <br /> <br />I Owner's Phone Number <br /> <br />Owner's NamEl I~(_ <br /> <br />Owner's Address i 55 n c" <br />, I Df)()J. '6,. a.AtJ.J;~JH~p <br />Fee Simple Titleholder Name ';mI <br /> <br />Fee Simple Titleholder Address I <br /> <br />II <br /> <br />Job Address <br /> <br />55Cl.o /'J 6-IH I 6 / vd! <br /> <br />~e Phtj r h; /}-St r7 3,/-d t/ q I Lot# <br />I Parcel# . ~~~~:~L~~L~~gfJr?u~Il;:)D2S~J <br /> <br />Sub Division <br /> <br />Bic-Hazard Waste Storage - ANNUAL <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 />D <br />D D <br />~ 8Jertj S~. D <br />D <br />D <br />D <br /> <br />Comm Exhaust Kitchen Hood/Duct <br /> <br />Controlled Bum <br /> <br />Emergency Generator < 30 kw <br /> <br />Emergency Generator> 30 kw <br /> <br />Fire Protection Maintenance - ANNUAL <br /> <br />Sprinkler <br />Fire Alarm <br /> <br />D <br /> <br />Hood Clean/Suppression <br /> <br />D Fire Alarm Installation <br />D Fire Pumps <br />D Fire Works <br />D Flammable Application- ANNUAL <br />D Fuel Tanks <br />D Other: I <br /> <br />Contractor 1 .~ ~ <br />Signature ~ <br /> <br />MOre.. PO ,Jr;, ~- c<~pq Fla <br />ELECTRICIANI <br />Signature . <br />Address I <br /> <br />Fumigation Tent <br /> <br />Hazardous Material (Tier II or RQ Facility) ANNUAL <br />Hood Installation <br /> <br />LP/Natural Gas-Installation <br />LP/Natural Gas-ANNUAL Sale <br />Places of Assembly-ANNUAL <br />Recreational Bum <br /> <br />Sparklers <br />Sprinkler System Installations <br />Standpipes (Sprinkler Sys) <br />Torch Roofing <br />Waste Tire Storage ANNUAL <br /> <br />Valuation of Project <br /> <br /> ! Company <br /> Registered <br />3Slf gJ License # <br /> I Company <br /> Registered <br /> I License # <br /> I Company <br /> Registered <br /> I License # <br /> U Company <br /> Registered <br /> I License # <br /> I Company <br /> Registered <br /> License # <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br />Signature <br /> <br />Address I <br /> <br />OTHER <br />Signature <br />Address <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 />. 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. I <br />Owner & Contractor sign back of application. notarized (Or. cop~ 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 I <br />Allow 10-14 davs for review aft..r ",.hmith., ri..t.. ! <br />