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<br />813-780-0020 <br /> <br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br /> <br />City of Zephyrhills Fire <br />Permit Application <br /> <br />1i 1t5ib <br /> <br />Fax-813-780-0021 <br /> <br /> <br />Phone Contact for Permit <br /> <br />~ <br /> <br />/0 <br /> <br />Owner's Phone Number I fr I J <br /> <br />II )11 112 L/ rYI <br />I <br />II II I <br />I <br /> <br />I <br />I <br />I "cg 'It /Ill E?U t<c! <br />I <br /> <br />I Titleholder Phone Number <br /> <br />Fee Simple Titleholder Name <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />I Lot# <br /> <br />2 [PI/fly' /t.1(J F( <br />1 <br /> <br />Parcel # <br /> <br />(Uts I AINcU I-KUM t-'KUt-'cK I Y I AX NU IIL;c) <br /> <br />D <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 />D Fumigation Tent <br />D Hazardous Material (Tier" 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 />Bio-Hazard Waste Storage - ANNUAL <br /> <br />Comm Exhaust Kitchen Hood/Duct <br /> <br />Controlled Bum <br /> <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br /> <br />Fire Protection Maintenance - ANNUAL <br /> <br />~ <br /> <br /> <br />Hood Clean/Suppression D <br /> <br />Sprinkler <br /> <br />Fire Alarm <br /> <br />Fire Alarm Installation <br />Fire Pumps <br /> <br />Fire Works <br /> <br />Flammable Application- ANNUAL <br /> <br />Valuation of Project <br /> <br />Fuel Tanks <br /> <br />Other: <br /> <br />Y I N I Fee Current <br /> <br />Contractor <br />Signature <br /> <br />Address I <br /> <br />ELECTRICIANI <br />Signature . <br /> <br />Address I <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHA~~,cALj , <br />Signatur~i ' .' <br /> <br />Ad1tess I <br /> <br />OTHER, "I <br />Signature" ." <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br /> <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />'\,\-"'" <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />'. ',. .~^..!.~~~....~: <br /> <br />:- <br /> <br />': . ~ :" .~' <br />- ,.' ;., *,,' t <br />~.r ~~ ~.: .~ ~ ~ ; <br /> <br />Company <br />Registered <br /> <br />'~-'i"""'~.. <br /> <br />Y/N <br /> <br />Y I N I Fee Current <br /> <br />Y/N <br /> <br />YIN <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Y/N I <br /> <br />Fee Current <br /> <br />Y/N <br /> <br /> <br />Address J License # <br />i;m~~*-ttitt~~@tm:ilii%Gi_~ij~&M.Mi,lmW$tr,]ili$#&i@0'~Jtikti;#;~W:ill&t4:'%jj'li!~&~~;;'~fu~1;l~"_~.2{'@ri'Wb'!Jg@.W5; <br />Directions: <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 />