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<br />813-780-0020 <br /> <br />Date Received <br /> <br />l{ '1~qq <br /> <br />City of Zephyrhills Fire <br />Permit Application <br /> <br />Fax-813-780-0021 <br /> <br />Phone Contact for Permit <br /> <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />I Rat L'~l.o/h <br /> <br />I Owner's Phone Number I 8" { ~ <br /> <br />I ~t:?~6 6af( give! Z-e/AvrA,i/fs. ~/. ~;r5Y( <br />, . <br /> <br />I R ~c1 . t-c k.L (:l'1 VI I Titleholder Phone Number I r 11 <br />. Jo.1' s-,.../ <br /> <br />Fee Simple Titleholder Name <br /> <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />II 7~.:2..11 ~~7~ <br />I <br />II 78"~ II ~;l.1~ <br /> <br />Lot # <br /> <br />Parcel # <br /> <br />D <br />D Fire Pumps <br />D Fire Works <br />D Flammable Application- ANNUAL. <br />D Fuel Tanks <br />D Other: <br /> <br />I ;{~!IwI- <br /> <br />;~ ~(!JX ~~7Y/ <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />Contractor <br />Signature <br /> <br />Address I <br /> <br />ELECTRICIANI <br />Signature <br /> <br />Address I <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 <br /> <br />D <br />D <br />ca---- <br /> <br />Fire Alarm <br />Hood Clean~~es~ <br />Fire Alarm Installation <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />Fumigation Tent <br />Hazardous Material (Tier II or RQ Facility) ANNUAL <br />Hood Installation <br /> <br />LP/Natural Gas-Installation <br />LP/Natural Gas-ANNUAL Sale <br />Places of Assembly-ANNUAL <br /> <br />Recreational Bum <br /> <br />Sparklers <br />Sprinkler System Installations <br />Standpipes (Sprinkler Sys) <br />Torch Roofing <br />Waste Tire Storage ANNUAL <br /> <br />;;zso..~ <br /> <br />Valuation of Project <br /> <br />I <br /> <br />st?"cie..-L ~/. 7J7W <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br />Signature . <br /> <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />Address <br /> <br />Directions: <br /> <br />Company <br />Registered <br /> <br />I Ere. S'T.Jfe,n.5 ~L. <br />WI N I Fee Current I WI N I <br />Is-t' y..rc;.r :J.6t!J~1 O>J)t:7 Y I <br /> <br />I Y I N I Fee Current Y I N I <br />I <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y / N I Fee Current <br /> <br />Y/N <br /> <br />Company <br />Registered <br /> <br />. Y I N I Fee Current <br /> <br />Y/N <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y I N I Fee Current <br /> <br />Y/N <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 />