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<br />City of Zephyrhills Fire ~ 1451 <br />Permit \A.pplication <br />I <br />I Phone Contact for Permit <br /> <br />813-780-0020 <br /> <br />Date Received <br /> <br /> <br />Fax-813-780-0021 <br /> <br /> <br />--Owner's Name <br /> <br />I' -:::fDHN' kvl/& <br />I '-f82-~r / iff);; Ih/ Sv,j~ (Z <br />I <br />I <br /> <br />I Owner's Phone Number II II <br />iU~1Z R1 <br />I Titleholder Phone Number II II <br /> <br />, Owner's Address <br /> <br />Fee Simple Titleholder Name <br /> <br />Fee Simple Titleholder Address <br /> <br />-job Address <br /> <br />7t>.5?J G.".-/ ( i3 Wl:> <br /> <br />I Lot# <br /> <br />2Cf>H~.jf, lis Fft- <br />I I <br />. Parcel # <br /> <br />Sub Division <br /> <br />lUt:l1 AINt:U I-KUM I-'KUI-'t:K I Y I AX NU 11l,;t:) <br /> <br />D Bio-Hazard Waste Storage - ANNUAL <br />D Comm Exhaust Kitchen Hood/Duct <br />D Controlled Bum <br />D Emergency Generator < 30 kw <br />D Emergency Generator> 30 kw <br />D Fire Protection Maintenance - ANNUAL <br />Sprinkler <br /> <br />'0 <br />o <br />o <br />o <br />o <br />o <br />o <br />o <br />o <br />o <br />,0 <br />o <br /> <br />Recreational Bum <br /> <br />Fumigation Tent <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 /> <br />Sparklers <br />Sprinkler System Installations <br />Standpipes (Sprinkler Sys) <br />Torch Roofing <br />Waste Tire Storage ANNUAL <br /> <br />Fire Alarm <br /> <br />o <br />o <br />o <br /> <br />~.~OOd Clean/Suppression <br />~ Fire Alarm Installation <br />D Fire Pumps <br />D Fire Works <br />D Flammable Application- ANNUAL <br />D Fuel Tanks <br />D <br /> <br />Zoo. (j'l) <br /> <br />Valuation of Project <br /> <br />Other: <br /> <br /> <br />Contractor Company <br />Signature Registered <br />Address i'2 License # <br />ELECTRICIANI I Company <br />Signature Registered <br />Address I I License # <br />PLUMBER Company <br />Signature Registered <br />Address I License # <br />MECHANICALI Company <br />Signature Registered <br />Address I License # <br />OTHER Company <br />Signature Registered <br />Address License # <br />Directions: <br /> <br />I Q'~~u~ent~ <br /> <br />I G.cCJOOO~81o I <br /> <br />I Y I N I Fee Current Y I N I <br />I I <br /> <br />I Y IN <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Y I N Fee Current <br /> <br />Y I N I Fee Current <br /> <br />Y/N <br /> <br />Fill out application completely. I <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 atter submittal date. <br />