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<br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />Fee Simple Titleholder Name <br /> <br />813-780-0020 <br /> <br />City of Zephyrhills Fire <br />Permit Application <br /> <br />:4Vl13S <br /> <br />Fax-813-780-0021 <br /> <br />13 s ~ l.lli6' .J. J~S--~-?:~J <br />I II II I <br />t ~I.ic< (, A 3 cr, 0 ~ ( ).3..P <br /> <br />, - <br />.J/ <br /> <br />FIVi^:JrA... y,w-\fo\!,o V.ile <br /> <br />Phone Contact for Permit <br /> <br />Owner's Phone Number <br /> <br />353 <br /> <br />'~e" l ~ tr'4' ~o'l.J.cr <br /> <br />~/fr <br /> <br />,~~/o<>( 5/h b7 () <br /> <br />I <br />I <br />I 5)'3,) G-q II <br />I ,/\I{* <br /> <br />I Titleholder Phone Number <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />Contractor <br />Signature <br /> <br />Address <br /> <br />ELECTRICIAN <br />Signature <br /> <br />Address I <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANICAL I <br />Signature . <br /> <br />Address I <br /> <br />II <br /> <br />" <br /> <br />I <br />I <br />II 1"4)'/ I <br />I <br /> <br />I3lvJ <br /> <br />I Lot# <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 />D Recreational Burn <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 />Parcel # <br /> <br />D <br />D <br />D <br />D <br />D <br />~ <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br /> <br />Comm Exhaust Kitchen Hood/Duct <br /> <br />Controlled Burn <br /> <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />Sprinkler D <br />Fire Alarm ~ <br /> <br />Hood Clean/Suppression D <br />Fire Alarm Installation <br /> <br />Fire Pumps <br /> <br />Fire Works <br /> <br />Flammable Application- ANNUAL <br /> <br />II ~~ -.;)./~DOiO -O?f'tlO-oolb <br />(OI:lIAINI::U J-HOM PHOPI::HI Y lAX NO II t; 1::) <br /> <br />Valuation of Project <br /> <br />Fuel Tanks <br /> <br />Other: <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br /> <br />Company <br />Registered <br />License # <br /> <br />Company <br /> <br />Registered <br /> <br />License # <br /> <br />OTHER <br /> <br />Signature <br /> <br />Address I <br /> <br />Directions: <br /> <br />Company <br />Registered <br />License # <br /> <br />A/"IfY"1 Cor '<? <br />Fee Current I Y I N <br /> <br />t-,'r1v.s <br /> <br />Q)/N I <br />1; F/)OO I). 00 <br />. <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Y/N <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. <br />