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<br />813-780-0020 <br /> <br />Date Received <br /> <br />OWner's Name <br /> <br />Owner's Address <br /> <br />.:p:- '1 t 7 c, <br /> <br />City of.Zephyrhills Fire <br />Permit Application <br /> <br />~ - 1- t:')!r Phone Contact for Permit <br /> <br />:2c f~Y r hi 1,15 Ylk-{~I "'I {.1 D ~ I Owner's Phone Number <br /> <br />Fax-813-78D-0021 <br /> <br /> <br />II <br /> <br />l J <br /> <br />I Titleholder Phone Number I <br /> <br />I <br />I <br />I 38c:J50 A 1J~ <br />I <br /> <br />Fee Simple Titleholder Name <br /> <br />II <br /> <br />II <br /> <br />,- <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />-~-w- - <br /> <br />------eJ <br />o <br />o <br />D <br />D <br />o <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />Contractor <br />Signature <br />Address <br /> <br />ELECTRICIAN <br />Signature I <br /> <br />Address I <br /> <br />PLUMBER <br /> <br />Signature <br /> <br />Address I <br /> <br />MECHANICALj <br />Signature . I <br /> <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />Address I <br /> <br />Directions: <br /> <br />B FUllliycttiulI T tlllt <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 />o Sparklers <br />o Sprinkler System Installations <br />D Standpipes (Sprinkler Sys) <br />D Torch Roofing <br />o Waste Tire Storage ANNUAL <br /> <br />Parcel # <br /> <br />_lI!:~A~ <br /> <br />1j1Q-t1azard Waste Storage - ANNUAL <br /> <br />Comm Exhaust Kitchen Hood/Duct <br /> <br />Controlled Bum <br /> <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ..umu.'L - <br />Sprinkler uzr /Lf <br />Fire Alarm D <br />Hood Clean/Suppression D <br />Fire Alarm Installation <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />ITT <br /> <br />I Lot# <br /> <br />I <br /> <br />~U~ I AINl::U t"KUM t"KUt"l::K I Y I AA l'lU 111..t:) <br /> <br />Fuel Tanks <br /> <br />Valuation of Project <br /> <br />Other: <br /> <br />",,",<<<<':-='--~ <br /> <br /> Company <br /> Registered <br /> License # <br />I Company <br />Registered <br />I License # <br />I Company <br />Registered <br />I License # <br />I Company <br />Registered <br />I License # <br />I Company <br />Registered <br />I License # <br /> <br /> <br />._. "'."V" <br /> <br />-,. <br /> <br />M .. <br /> <br />.5/~P J.e~ {;rr.nn.. {( <br />Y/N I Fee Current I Y/N I <br />I <br /> <br />Y/N I FeeCurrerit Y/N I <br />I <br /> <br />I <br />I <br />I <br />I <br />I <br />1- <br />"J <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Y/N I <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />.~. ---- ,.,. <br /> <br />~'" . ,~.~tT' ~- . -. '. ,~,,' <--".~ ~'~"'ri"'A.~.~' <br /> <br />Fill out application completely, <br />OWner & Contractor sign back of application, notariZed (Or, copy ofSigned 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 1 D-14 days for review after submittal date. <br />