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<br />.w~:i_.~~L~t.~1!;;;!,~i~,2", ..! <br />I tJ A 1-1. / J, III ( 4- <br />5 ~ r-l L 0 L I~~/ <br /> <br />8'13-780-0020 <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />City of.Zephyrhills Fire Fax-813-780-0021 <br />Permit Application <br />,IIi mr- ,_ _,;~~~; Contact for Pe~it ~,!!l,"- ,~"..~J,~!Q_UJ ~,","!.~_., <br />rr Owner's Phone Number I $ , 1 11-' ,..r II" I I ., <br />~ <br /> <br />r .:ce h c-l-r./li FL JIr 1.- <br /> <br />:::r tV '- <br /> <br /> <br />Fee Simple Titleholder Name <br /> <br />Titleholder Phone Number <br /> <br />II <br /> <br />II <br /> <br />71 <br /> <br />~- ITii~i~trfWli~-~~-~~~~ <br /> <br /> <br />I Lot# <br /> <br /> <br />I V1- 2.lrtJ 1- t'1.10-t?P/PO- pC/it? <br /> <br />lUtll AII'III:.U rt'(UIVI t"'t'(ut"'l:.t'( I Y I",^ I'IIU III.JI:.) <br />'l' Wi? _.;,l~ ~~"'1'i~UJfiNmmVT&:."mIlm~t <br /> <br />Fee Simple Titleholder Address <br /> <br />a:::=s-~~'md~I~:~ -~~ ~ ~L~~ <br /> <br />Sub Division <br /> <br />M!M~~1'?nxd~~~.~f~~ ~W-=Wi~i"=-'ftJlitT'~'-fiII <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br /> <br />- !il;lt;;'ii'R <br /> <br />Parcel # <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />Comm Exhaust Kitchen HoodlDuct <br /> <br />D <br />o <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />Controlled Bum <br /> <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br /> <br /> Sprinkler D <br /> Fire Alarm D <br /> Hood Clean/Suppression D <br />D Fire Alarm Installation <br />D Fire Pumps <br />D Fire Works <br />@ Flammable Application- ANNUAL <br />D Fuel Tanks <br />D Other: <br /> <br />~~~~~I/jI~ <br /> <br />Contractor <br />Signature <br />Address I <br /> <br />Fumigation Tent <br />Hazardous Material (Tier 1\ or RQ Facility) ANNUAL <br />Hood Installation <br />LP/Natural Gas-Installation <br />LP/Natural Gas-ANNUAL Sale <br />Places of Assembly-ANNUAL <br /> <br />Recreational Bum <br /> <br />"' ".r-lO ~OO <br />I<ff""L " , <br />1~ /lo..n f"t '1,,-~r <br />Pf\-~^~ <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 /> . - <br /> I Company I <br /> Registered <br /> I License # I <br /> I Company I <br /> Registered <br />I License # I <br />I Company I <br />Registered <br />I License # I <br />I Company I <br />Registered <br />I License # I <br />I Company I <br /> Registered <br /> License # <br /> <br />ELECTRICIAN <br />Signature I <br /> <br />Address I <br /> <br />I <br /> <br />PLUMBER <br /> <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br />Signature <br /> <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />~'l <br /> <br />~ <br /> <br />_ lL <br /> <br />~ <br /> <br />Y I N I Fee Current <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Y I N Fee Current <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 />Y/N <br /> <br />Y/N <br /> <br />Fee Current <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 />