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<br />813-780-0020 <br /> <br />Date Received <br /> <br />OWner's Name <br /> <br />OWner's Address <br /> <br />-5" ~~ <br />FICK(Cj~ tJo...7p. ~^, ~h.--lt~ <br /> <br />City of.Zephyrhills Fire <br />Permit Application <br /> <br />~169o <br /> <br />Fax-813-780-0021 <br /> <br />Phone Contact for Permit <br /> <br /> <br />OWner's Phone Number <br /> <br />II <br /> <br />Fee Simple Titleholder Name <br /> <br />II <br /> <br />I <br />! <br />17D5O b11 J3/. <br />I <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />-0 <br />D <br />D <br />D <br />D <br />D <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />I Titleholder Phone Number I <br /> <br />II <br /> <br />tllo-Mazard \lvaSte Storage - ANNltAL <br />Comm Exhaust Kitchen HoodlDuct <br /> <br />Controlled Bum <br /> <br />. Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance ~U~ <br />Sprinkler D <br />Fire Alarm 0 <br />Hood Clean/Suppression D <br />Fire Alarm Installation <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br /> <br />Other: <br /> <br />Contractor Company I <br />Signature Registered <br />Address I Lf7t:)( CX&k PtMr I!(,~ -r~ ~ "1'J~ License # I <br />ELECTRICIAN I Company I <br />Signature I Registered <br />Address I I License # I <br />PLUMBER I I Company I <br />Signature Registered <br />Address I I License # I <br />MECHANIC4 I Company I <br />Signature Registered <br />Address I I License # I <br />OTHER I Company I <br />Signature Registered <br />Address I I License # <br />Directions: <br /> <br />Lot # <br /> <br />Parcel # <br /> <br />I <br /> <br />(Utl. AINt:U r-~UIVl t"~Ut"t:~. r I "'^ I~U 11\..t:) <br /> <br />EI l"umiycdiulI T .:II! <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 />-lI:5m <br /> <br />I . f Valuation of Project <br /> <br />t5Jm-rtI~ 6-t-.ne<eJf <br />Y IN r Fee Current Y I N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Y/N I Fee Current I Y/N I <br /> I <br />Y/N I Fee Current I Y/N I <br /> I <br />Y/N I Fee Current I Y/N I <br /> _... I <br /> <br />All out application completely. <br />OWhef'& .ContractbFsigrfl)aCk-of apPlicafi6i1;notaJiZed{Ot,-cop~njfsignecr roiltractWitl1 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 />