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<br />813-780-0020 <br /> <br />Date, Re~ived <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />City of Zephyrhills Fire. <br />Permit V\ppfication W/l. <br />I <br />I <br /> <br />!LA S,2.L 0 HoP.. Vf)-TH <br />/230Jt Pm-O Hrl C f1:A-RJ4. <br />I <br />I <br /> <br />ICHATTeRBOX CAr-I: <br />I <br /> <br />Fee Simple Titleholder Name <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br /> <br />I <br />PL <br /> <br />Owner's Phone Number <br /> <br />'Ru~ KIN <br /> <br />Ig/3 <br />FL <br />I <br /> <br />I Titleholder Phone Number <br /> <br />pO/if G~LL <br />! I <br />Parcel # . <br /> <br />II <br /> <br />"I <br /> <br />BLV/). <br /> <br />I Lot# <br /> <br />(Utll AINt:.U I-KUM t-'KUt-'t:.K I Y I AX. NU 11L;t:.) <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 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 />Bio-Hazard Waste Storage - ANNUAL . <br />Comm Exhaust Kitchen HoodlDuct <br />Controlled Bum <br /> <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />Sprinkler D <br />Fire Alarm D <br />Hood Clean/Suppression D <br />Fire Alarm Installation <br /> <br />Fire Pumps <br /> <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Other: <br /> <br />lcoMPLE-1 C <br /> <br />I <br />cXffIHIST AA/LJ <br /> <br />Fuel Tanks <br /> <br />I~~ <br /> <br />Contractor <br />Signature <br /> <br />Address I <br /> <br />ELECTRICIANj <br />Signature <br /> <br />Address I <br /> <br />PLUMBER <br />Signature <br />Address I <br />MECHANICALI <br />Signature . <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />I <br /> <br />Address <br /> <br /> ! I Company <br /> Registered <br />, I License # <br />I I Company <br />Registered <br /> License # <br /> Company <br /> Registered <br /> License # <br /> Company <br /> Registered <br /> License # <br /> Company <br /> Registered <br /> License # <br /> <br />I Valuation of Project <br />HdOLJ CL54A/IA/(; <br /> <br />~~t/f~:~rren~r~t',ffS <br />I <br /> <br />Y / N I Fee Current Y / N I <br /> <br />I <br /> <br />Y / N I Fee Current Y / N I <br />I <br /> <br />Y I N I Fee Current Y I N I <br />I <br /> <br />Y I N I Fee Current Y I N I <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. <br />