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<br />813-78D-0020 <br /> <br />. ... <br />Date Reveived <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />{t-15i 5 <br />:::::::::" i~~" ~7~H~' <br /> <br />City of.Zephyrhills Fire <br />Permit Application <br /> <br />Fax-813-78D-0021 <br /> <br />!~-/~~~mJ-' <br />r~""''''! 8 "~~r <br /> <br />(Vl~J, <br /> <br />Fee Simple Titleholder Name <br /> <br />I <br />I <br />I~ lo-th. A~ <br />I <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />MtJ1.J1 <br /> <br />-0 <br />o <br />o <br />o <br />o <br />o <br /> <br />I Titleholder Phone Number I <br /> <br />II <br /> <br />II <br /> <br /> <br />tslo-l1azard Waste Storage - ANNUAL <br />Comm Exhaust Kitchen HoodlDuct <br />Controlled Bum <br />. Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance~ <br />Sprinkler 0 <br />Fire Alarm G" <br />Hood Clean/Suppression D <br />o Fire Alarm Installation <br />o Fire Pumps <br />o Fire Works <br />o Flammable Application- ANNUAL <br />o Fuel Tanks <br />o Other: <br /> <br />Contractor <br />Signature <br />Address <br /> <br />ELECTRICIAN <br />Signature I <br /> <br />Address I <br /> <br />I <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANIC' <br />Signature <br /> <br />Address I <br /> <br />OTHER <br /> <br />Signature <br /> <br />Address '_... <br /> <br />Directions: <br />FlII out application completely. <br />OWner & COntractor sigh 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 /> <br />.-.. .. -- <br /> <br />'i~~' <br /> <br />- <br /> <br />Ilwr <br /> <br />I Lot# <br /> <br /> <br />Po"",' -I IV" ''''NoU 'KVM "KWoK " ''''' N~ "C,,' <br /> <br />B FUIII;~~~~II 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 />lf2'iF <br /> <br />. , Valuation of Project <br /> <br />I <br />, <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br />Company I <br />Registered <br /> <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br />i <br /> <br />~~,.."~--.~ <br /> <br />5t1'n~ kf' 60. r'Jf1-e 11 <br />Y IN Fee Current L Y IN <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />Y/N I <br /> <br />Fee Current I <br /> <br />Y/N <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />Y/N I <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />Y/N I <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />Y/N I <br /> <br />License # <br /> <br />I Y IN I <br />J <br /> <br />Fee Current <br /> <br />~ . ,.~,,"~~w <br />