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<br /> <br />)ate Received <br /> <br />)wner's Nam~ <br /> <br />)wner's Address <br /> <br />Cityof.Zephyrhills Fire, <br />Permit Application <br /> <br />Fax-813-780-0021 <br /> <br />I <br />f <br />! <br /> <br />I <br />I <br />730{D <br /> <br />'ee Simple Titleholder Name <br /> <br />ee Simple Titleholder Address <br /> <br />Db Address <br /> <br />ub Division <br /> <br />o <br />o <br />o <br />o <br />o <br />o <br /> <br />~ <br />o <br />o <br />o <br />o <br />o <br /> <br />gnature <br /> <br />Address I <br /> <br />=CHANICAL/ <br />~nature , <br /> <br />Address I <br /> <br />Phone Contact for Permit <br /> <br /> <br />Owner's Phone Number <br /> <br />IIPlo <br /> <br />/J!J{p-:j II jZOO <br /> <br />I Titieholder Phone Number <br /> <br />II <br /> <br />II <br /> <br />a /J-II 31v#/ <br />I <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br /> <br />o <br />D <br />D <br />o <br />D <br />o <br />D <br />o <br />Hood Clean/Suppression D 0 <br />Fire Alarm Installation - ~\~ 0 <br />Fire Pumps 6b ~ ~ 0 <br />o <br /> <br />Comm Exhaust Kitchen HoodlDuct <br /> <br />Controlled Bum <br /> <br />, Emergency Generator < 30 kw <br /> <br />Emergency Generator> 30 kw <br /> <br />Fire Protection Maintenance - ANNUAL <br /> <br />Sprinkler <br /> <br />~ <br /> <br />Fire Alarm <br /> <br />Fire Works <br /> <br />Flammable Application- ANNUAL <br /> <br />FuelTanks <br /> <br />Jk./l/h'~~ <br />Parcel # ./ <br /> <br />I Lot# <br /> <br />A- tl'5 <br /> <br />\Ut:SI AIJ'Ill:.U J-KUIVI t"'KUt"'l:.KJ T lAAI'\lUIII....~) <br /> <br />. ~E <br /> <br />Fumigation Tent <br />Hazardous Material (Tier II or RQ Facility) ANNUAL <br />Hood Installation <br />LP/Natural Gas-Installation <br /> <br />LP/Natural Gas-ANNUAL Sale <br />Places of Assembly-ANNUAL <br /> <br />KQ.p~~~ <br />rtr~ <br /> <br />Recreational Bum <br /> <br />Sparklers <br />Sprinkler System Installations <br />Standpipes (Sprinkler Sys) <br />Torch Roofing <br />Waste Tire Storage ANNUAL <br /> <br />1 Of) <br /> <br />CC? <br /> <br />Valuation of Project <br /> <br />'Other: <br /> <br />I <br /> <br />:mtractor I' ',v~ - ,//" I Company <br />gn_1ure . ~ - Q/ ~ ~eg;_ <br />Add""" I O:f(.f/l~ ~~,R pi lJIl-bF..C"Ty F/_j~icense# I <br />.ECTRICIAN Company I <br />gnature I Registered <br />Address L I License # I <br /> <br />.UMBER I I I <br />II <br />I I <br />I I <br />I <br />__~. I <br /> <br />-HER <br /> <br />~nature <br />Address L_ <br />'ections: <br /> <br />.......... <br /> <br />.,~--.--..,.._.~,- <br /> <br />.~ <br /> <br />I~e\~ ~D.jD <br />{ N Fee' Current IN <br /> <br />GF.. fX)~ IDLI (p <br /> <br />--. <br /> <br />Y/N I <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Company <br />Registered <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />, ' Fee Current <br /> <br />Y/N <br /> <br />Y/N <br /> <br />License # <br /> <br />Company I <br />~egistered J <br /> <br />LIcense # <br /> <br />Y/N <br /> <br />_F":~.I_ . <br /> <br />Y IN I <br />I <br />1 <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 />