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<br />Fee Simple Titlehoider Name <br /> <br />813-780-0020 <br /> <br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />/ j ~Of <br /> <br />Phone Contact for Permit, '! <br /> <br />Cant TO 1,.InC.1 Owner's Phone Number I ~ 52 II 5 J' 31./ 3"33.2 I <br /> <br />[,--tv J F'- 33S~3 <br />/ ' <br />I Titleholder Phone Number I <br /> <br />City of Zephyr hills Fire <br />Permit Application <br /> <br />Fax-813-780-0021 <br /> <br />I <br />IJvturre..JJ fe-sf <br />l;lo7/cf' Hwy,.-gt:)/ N. . Dade <br /> <br />, , <br /> <br />I <br />I <br /> <br />u <br /> <br />u <br /> <br />I <br /> <br />II <br /> <br />II <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Lot # <br /> <br />Sub Division <br /> <br />5/;2.3- q-b <br /> <br />S-t # z-I-ILi-Ls FL 335'-10 <br /> <br />Parcel # <br /> <br />I '~~tj ~;t;:;;L:MO~O!U~;K I rtf, ~ ~u ~I!::{ I () <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 />Bio-Hazard Waste Storage - ANNUAL <br />Comm Exhaust KItchen HoodlDuct <br />Controlled Bum <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />Sprin~er D <br />Fire Alarm D <br />Hood Clean/SuppressionD <br />Fire Alarm Installation <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL _ <br /> <br />~ 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 (Sprin~er Sys) <br />D Torch Roofing <br />D Waste Tire Storage ANNUAL <br /> <br />Fuel Tanks <br /> <br />Valuation of Project <br /> <br />Other: <br /> <br />Contractor <br />Signature <br /> <br />Address I <br /> <br />ELECTRICIANI <br />Signature , <br /> <br />Address I ' <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANICAL.] <br />Signature 1 <br /> <br />Address I <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y IN I <br />I <br /> <br />Y IN I <br />I <br /> <br />Y IN I <br />I <br /> <br />Y INI <br />I <br /> <br />Y IN I <br />J <br /> <br />Y / N Fee Current <br /> <br />Y IN, I Fee Current <br /> <br />Company, <br />Registered <br /> <br />License # <br /> <br />Y l N I Fee Current <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />_ Y I N I Fee Current <br /> <br />.1 <br /> <br />OTHER <br />Signature <br /> <br />'Address I <br /> <br />Directions: <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y / N I Fee Current <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 />