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<br />'.. <br /> <br />813-780-0020 <br /> <br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />Fee Simple Titleholder Name <br /> <br />l41'{tt6 <br /> <br />City of Zephyrhills Fire <br />Pe'Eit \A.pplication <br /> <br />O~ 1 G 108: Phone Contact for Permit <br /> <br />Fax.813-780-0021 <br /> <br /> <br />':FO/l. <br />I '-~2LO HO~VA-Tff <br />12304 J>OTOMttC MtfRK P4- <br />I <br />I <br />11-101{ RISON <br />I <br /> <br />18/-3 <br />33S7CJ <br /> <br />I I Sf.? II c:rSSI I <br />I <br />I <br />I <br /> <br />I Owner's Phone Number <br /> <br />ltJ$K fAl FL. <br /> <br />II <br /> <br />II <br /> <br />I Titleholder Phone Number <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />Parcel # <br /> <br />I <br />i 1- J..b.. Z( _DOlo - /2/ao - 02- SCf- <br /> <br />(Uti I AINt::U I-KUM I-'KUI-'t::K 1 Y I AX NU 11\,;t::) <br /> <br />I Lot# <br /> <br />51f20 G'II-L4 '8LVlJ <br />I <br /> <br />o <br />o <br />o <br />D <br />o <br />[2] <br /> <br />D <br />o <br />D <br />o <br />o <br />D <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br />Comm Exhaust Kitchen Hood/Duct <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 />Controlled Bum <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />Sprinkler D <br />Fire Alarm D <br />Hood Clean/Suppression D <br />Fire Alarm Installation <br /> <br />Fire Pumps <br /> <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />I <br />Cl-E,., AI /AI G <br /> <br />Valuation of Project <br /> <br />Other: <br /> <br />ICoMPL.6'Te s.}(-fh1usr <br /> <br />Contractor ~ ~ i I Company tlNIVFRSf; S~RV{C5S <br />Signature Registered Y I N Fee Current Y I N <br />Address I I I License # I <br />ELECTRICIAN I I Company <br />Signature Registered Y/N I Fee Current Y/N I <br />Address I License # I <br />PLUMBER Company <br />Signature Registered YIN I Fee Current Y/N I <br />Address I License # I <br />MECHANICALI Company <br />Signature Registered Y/N I Fee Current Y/N I <br />Address I License # I <br />OTHER Company <br />Signature Registered Y/N I Fee Current Y/N I <br />Address License # <br />Directions: <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 after submittal date. <br />