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<br />It./L sr,KJfL LE.4;t//A/tL <br />I S"i9 ..J i <br /> <br />Fee Simple Titleholder Name I <br /> <br />I <br />I Si<> '$ 'I L!!1 m ~ z: <br /> <br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />. 813-780-0020 <br /> <br /> <br />City of Zephyrhills Fire <br />Permit Application <br /> <br />CCIVTA:A.. <br /> <br />/t!? 7){ sr <br /> <br />Fax-813-780-0021 <br /> <br />Phone Contact for Permit <br /> <br /> <br />Owner's Phone Number <br /> <br />II <br /> <br />II <br /> <br />I Titleholder Phone Number I <br /> <br />II <br /> <br />II <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />I Lot# <br /> <br />Parcel # <br /> <br />Contractor <br />Signature <br />Address <br />ELECTRICIANI <br />Signature . <br />Address I <br />PLUMBER <br />Signature <br />Address I <br />MECHANICALI <br />Signature . <br />Address I <br />OTHER <br />Signature <br />Address <br /> <br />o <br />D <br />D <br />o <br />D <br />o <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br />Comm Exhaust Kitchen Hood/Duct <br />Controlled Bum <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - A~~n~~ ~~~ <br /> <br />Sprinkler D 0 0' 0 L---' <br /> <br />~~ D 0 0 Xc=J <br />Hood Cleaning 0 0 0 0 C=:J <br />Hood Suppression D 0 0 0 c=J <br />Fire Alarm Installation <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br />Fuel Tanks <br />Other: <br /> <br /> <br />o <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />o <br /> <br />Fumigation Tent <br />Hazardous Material (Tier II 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 /> <br />Sparklers <br />Sprinkler System Installations <br />Standpipes (Sprinkler Sys) <br />Torch RoofinglTar Kettle <br />Waste Tire Storage ANNUAL <br /> <br />Valuation of Project <br /> <br />Company <br /> <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Company <br /> <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y/N <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 />License # <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Directions: <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, Parcel # - obtained from Property Tax Notice (http://appraiser.pascogov,com) <br />