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<br />Date Received <br /> <br /> <br />City of Zephyr hills Fire <br />Permit Application <br /> <br />1ii031 <br /> <br />Fax-81 ~780-0021 <br /> <br />81~780-0020 <br /> <br />one Contact for Pennlt <br /> <br /> <br />',. <br /> <br />YtlL("(,e'-1/ est Contra I J.5"'c7t 115tf31J333~ <br />~07/1l l-/u'Y' 30/' N. ,1 J)ade ei-fy j FL 335...23 I <br /> <br />I . I TltleholderPhone Number I II '"' I <br />I I <br /> <br />1.s:gOL! -Ih +h 51-., <br /> <br />, <br /> <br />I <br /> <br />.z~p)1'jrh'- l Ls ) <br />I <br /> <br />FL <br /> <br />Lot # <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />Fee Simple Titleholder Name <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />Parcel # <br /> <br />I <br />(Utll AINcU t-KUM f-?KUt-'cK I Y I AX NU IIl;c) <br /> <br />D Bio-Hazard Waste Storage - ANNUAL <br />D Comm Exhaust Kitchen HoodlDuct <br />D Controlled Bum <br />D Emergency Generator < 30kw <br />D Emergency Generator> 30 kw <br />D Fire Protection Maintenance - ANNUAL <br />Sprinkler D <br />I <br />Fire Alann D <br />Hood Cl8an/suppressionD <br />D Fire Alann Installation <br />D Fire Pumps <br />o Fire Works <br />D Flammable Application- ANNUAL" <br />D Fuel Tanks <br />D Other: <br /> <br />Contractor gl fl r~ I <br />Slgnatu.. -ry- J11 fj/l ~. <br /> <br />Address _ <br /> <br />ELECTRICIANI <br />Signature . <br /> <br />Addres~ I <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANICALj <br />Signature . <br /> <br />Address I <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 (Sprinkler Sys) <br />D Torch Roofing <br />D Waste Tire Storage ANNUAL <br /> <br /> t r Valuation of Project <br />! Company I fJl!~rrfll Pee;( ~~ ( <br />Registered ' Y I N Fee Current I Y I N <br />License # I I <br />I Company I <br />Registered Y IN ,I Fee Current Y/N I <br />I Ucense # I I <br />I Company I <br />Registered YIN I Fee Current Y/N I <br />I License 1f.. I I <br />I Company I <br />Registered .Y IN I Fee Current Y/N I <br />, License # I I <br />I Company ! <br />Registered Y/N , Fee Current Y/N I <br />011 License # I <br /> <br />OTHER <br />Signature <br /> <br />'Address I <br /> <br />Directions: <br /> <br />.1 <br /> <br />FiJI 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 />