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<br />813-780-0020 <br /> <br />. <br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />City of.Zephyrhills Fire }!' 1 Ct!( - <br />Permit Application Y y:J <br /> <br />Phone Contact fo Permit 1 <br /> <br />~ --:5- -.:1 (X)cr <br />:~ /,.((~ I-I....II"-,J- fd..J-".b <br /> <br />I Owner's Phone Number <br /> <br />Fax-813-780-0021 <br /> <br /> <br />II <br /> <br />II <br /> <br />II <br /> <br />I Titleholder Phone Number I <br /> <br />Fee Simple Titleholder Name <br /> <br />I <br />I <br />173jD n c:b..l'-Y <br />I <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />IB, <br /> <br />Parcel # <br /> <br />I Lot# <br /> <br />I <br /> <br />tUl>IAII'll::U t"KUIVlI"'KUI"'t:KI Y 1JV.I'lUIll-l::) <br /> <br />-TI <br />D <br />D <br />D <br />D <br />D <br /> <br />D <br />D <br />D <br />o <br />D <br />D <br /> <br />Contractor <br />Signature <br /> <br />Address I <br /> <br />ELECTRICIAN <br />Signature I <br /> <br />Address I <br /> <br />I <br /> <br />l>1D-Hazard Waste Storage - ANNUAL <br /> <br />EJ FUllliYdliulI T tlllt <br />o Hazardous Material (Tier II or RQ Facility) ANNUAL <br />o 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 />o Sparklers <br />o Sprinkler System Installations <br />D Standpipes (Sprinkler Sys) <br />D Torch Roofing <br />o Waste Tire Storage ANNUAL <br /> <br />f!:t~ -r.~ Pi- ,,,,q <br />I <br /> <br />Comm Exhaust Kitchen HoodlDuct <br /> <br />Controlled Bum <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance -~ <br />Sprinkler ~ <br />Fire Alarm D <br />Hood Clean/Suppression D <br />Fire Alarm Installation <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />Other: <br /> <br /> <br />'-I7eJ( C)Q.k... Pc-cr <br /> <br />OTHER <br />Signature <br /> <br />Address I <br /> <br />Directions: <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />.1 Valuation of Project <br /> <br />l5jrn-~/.v b-t-.OE~J( <br />Y I N Fee Current Y I N <br /> <br />Y I N I Fee Current <br /> <br />Y/N <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANIC4 <br />Signature . <br /> <br />Address I <br /> <br />I <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 />Fill out application completely. <br />owner & .Contractofsign-I)aCk-ot applicatioti;:ootariZecl10t;copy-Ofsignea contractWitli 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 />