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<br />813-780-0020 <br /> <br />Date Received <br /> <br />Owners Name <br /> <br />Owners Address <br /> <br />City of-Zephyrhills Fire <br />Permit Application <br /> <br />,(f 1b <D 1/ <br /> <br />Fax-813-780-0021 <br /> <br />s-- <br />I F/(::md, ~f:J .~Ay6hd/~ <br />I <br /> <br /> <br />Phone Contact for Permit <br /> <br />Owners Phone Number <br /> <br />II <br /> <br />I <br />I <br />/7!f50 &11 13/vd- <br />I <br /> <br />I Titleholder Phone Number I <br /> <br />II <br /> <br />/I <br /> <br />Fee Simple Titleholder Name <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />-----0 <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 />I Lot# <br /> <br />Parcel # <br /> <br />~ Ul:S I AINl::.U r-KUM /"'KU/"'t:K I I I FV- NU Ilvt:) <br /> <br />El FUllligdtiUII T ..Ill <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 ReaeationalBum <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 />... <br /> <br />l:Slo-Hazartl "vaste Storage - ANNUAL <br /> <br />Comm Exhaust Kitchen HoodlDuct <br /> <br />Controlled Bum <br /> <br />. Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ~ <br />Sprinkler [l2( <br />Fire Alarm D <br />Hood Clean/Suppression D <br />Fire Alarm Installation <br /> <br />Yr <br /> <br />Fire Pumps <br /> <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />., Valuation of Project <br /> <br />Other: <br /> <br /> <br />Contractor <br />Signature <br /> <br />Address I <br /> <br />ELECTRICIAN <br />Signature I <br /> <br />Address I <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANICAL!. <br />Signature . I <br /> <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />Address I <br /> <br />Directions: <br /> <br /> Company J <br /> Registered <br />I!t. "7.~ f2I... ., ""q Ucense # I <br /> I Company I <br /> Registered <br /> I License # I <br /> I Company I <br /> Registered <br /> I License # I <br /> I Company I <br /> Registered <br /> I Ucense # I <br /> I Company ! <br /> Registered <br /> I Ucense # <br /> <br />L'S, fTl'((J I~ 6-t-. ne If <br />Y / N r Fee Current Y I N <br /> <br />Y I N I Fee Current . <br /> <br />Y/N <br /> <br />Y/N I Fee Current I Y/N <br />Y/N I Fee Current I Y/N <br />Y/N I Fee Current I Y/N I <br /> -~~ l <br /> <br />All out application completely. <br />OWhet&ConttacrotsigiioaClc Of applicatioh~notariZea{Ot ,C6py~ofsignea oohtract:Witll 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 />