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<br />813-780-0020 <br />. <br /> <br />City of Zephyrhills Fire <br />Permit Application <br /> <br />Date Received <br /> <br /> <br />c;,o (Lf <br /> <br />#- 1 f77 <br /> <br />Fax-813-780-0021 <br /> <br /> <br />Phone Contact for Pennit <br /> <br />II <br /> <br />II <br /> <br />Owner's Name <br /> <br />3fK\-L~ <br />71.{.) ~ <br /> <br />D~PT. <br /> <br />-:4= 3D Owner's Phone Number <br />Z'E?H '/~giLlS <br /> <br />Owner's Address <br /> <br />&A-tL.. (;L Vf) . <br /> <br />II <br /> <br />Fee Simple Titleholder Name <br />Fee Simple Titleholder Address <br /> <br />II <br /> <br />I Titleholder Phone Number <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />114 .1 ~ (;rA\..1. ~ Lv D. <br /> <br />I <br /> <br />Parcel # <br /> <br />I Lot# <br /> <br />(Uts I AINt:U I-KUM t-'KUt-'t:K I Y I AX NU 11L;t:) <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 />D Bio-Hazard Waste Storage - ANNUAL <br />D Comm Exhaust Kitchen Hood/Duct <br />D Controlled Bum <br />D Emergency Generator < 30 kw <br />D Emergency Generator> 30 kw <br />~ire Protection Maintenance - ANNUAL <br />Sprinkler D J <br />f';ll ,^",i'C. <br />Fire Alann ~ r" <br />Hood Clean/Suppression D <br />D Fire Alann Installation <br />D Fire Pumps <br />D Fire Works <br />D Flammable Application- ANNUAL <br />D Fuel Tanks <br />D Other: I <br /> <br />c~ntractor ~ f X11 I If I <iT) <br />Signature -==== U~!!;?-- <br /> <br />Address <br /> <br />ELECTRICIANI <br />Signature . <br /> <br />Address I <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br />Signature . <br /> <br />Address I <br /> <br />Valuation of Project <br /> <br />OTHER <br />Signature <br /> <br />I <br /> <br />Address <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 />Company <br /> <br />Registered <br /> <br />License # <br /> <br />Company <br /> <br />Registered <br /> <br />License # <br /> <br /> <br />Y / N I Fee Current <br /> <br />Y/N <br /> <br />Y I N I Fee Current <br /> <br />Y/N <br /> <br />Y I N I Fee Current <br /> <br />Y/N <br /> <br />Y I N I 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. <br />