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<br />813-780-0020 <br /> <br />i~t;~;W~:;::~:i~l@ntil!%ffiiliiGLi"<" <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />~l ~ V( <br /> <br />Fax-813-780-0021 <br /> <br />City of Zephyrhills Fire <br />Permit Application <br /> <br />,,~;2,=L~~~L_~~__~____n$_tiF_%1r4W<~~:::';~i~~~=~~"iJ,,@~~~.Jl:2,~~",tli~,e~~,1 <br />I 'PJ3 II ,..7,9IIJG// I <br />L 3:3 tP S"rJ.. <br />I II <br /> <br /> <br />Fee Simple Titleholder Name <br />Fee Simple Titleholder Address <br /> <br />~ ~~,~~~~~mll"," <br /> <br /> <br />D Other: I <br /> <br />~~~:~~::rl ~ ~ I <br /> <br />Address 15~ 7/ kI. WilLe t',j AVP--j 7il~a F.L :!J.3lY <br />ELECTRICIAN <br />Signature <br />Address I I <br /> <br />I <br />I <br />I <br />I <br />I <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />PLUMBER <br /> <br />Signature <br />Address I <br />MECHANICALI <br />Signature <br />Address I <br /> <br />OTHER <br /> <br />Signature <br /> <br />Address <br />Directions: <br /> <br />I <br />159:3/ r;. to. / / ~/y el, <br /> <br />I Lot# <br /> <br />(Ac..c ell! /f "Y'~eLi,}l) <br /> <br />I Parcel # L <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 /> <br />D Recreational Bum <br />D Sparklers <br />D Sprinkler System Installations <br />D Standpipes (Sprinkler Sys) <br />D <br />D <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br />Comm Exhaust Kitchen Hood/Duct <br />Controlled Bum <br /> <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />~~~~ <br />Sprinkler D 0 0 0 L-J <br />~D DXc=J <br />Do DOc=J <br />DODoc=J <br /> <br />Fire Alarm <br /> <br />Hood Cleaning <br /> <br />Hood Suppression <br /> <br />Fire Pumps <br /> <br />Fire Works <br /> <br />Flammable Application- ANNUAL <br /> <br />Torch RoofingfTar Kettle <br />Waste Tire Storage ANNUAL <br /> <br />Valuation of Project <br /> <br />lit Dr r e c '-<-'r /1Y. ...5ervlc e.s I <br />. Y I ~ Fee Current ~ I N I <br />I E"F GJPt'//~:3 I <br /> <br />I Y / N Fee Current Y I N I <br />I I <br /> <br />I Y / N I Fee Current <br />I <br /> <br />I Y IN <br />I <br /> <br />I Y I N <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br /> <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Company <br /> <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Company <br /> <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />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. Parcel # - obtained from Property Tax Notice (http://appraiser.pascogov.com) <br />