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<br />813-780-0020 <br /> <br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />tf11~5 <br />"' frJ~ <br />I <br /> <br />Fax-813-780-0021 <br /> <br />City of Zephyr hills Fire <br />Permit Application <br /> <br />J~~or.Y <br />: .2f';~.-h; 147(f1"Vr: <br /> <br />Phone Contact for Permit <br /> <br />NIVS ~ <br />~I owne~s Phone Number <br /> <br />LJ~.~ 7~ U~,t~-L"" <br />II II <br /> <br />I <br />I <br />IJS>d- 5U A-Auc- <br />I <br /> <br />Fee Simple Titleholder Name <br /> <br />1I'Jr;;J <br /> <br />Fee Simple Titleholder Address <br /> <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />-El <br />D <br />D <br />o <br />@ <br /> <br />o <br />o <br />o <br />D <br />o <br />o <br /> <br />Contractor <br />Signature <br />Address <br /> <br />ELECTRICIAN <br />Signature , <br /> <br />Address I <br /> <br />PLUMBER I <br /> <br />Signature <br /> <br />Address I <br /> <br />MECHANIC' <br />Signature . <br /> <br />Address I <br /> <br />olo-Hazard waste Storage - ANNUAL <br /> <br />Comm Exhaust Kitchen Hood/Duct <br /> <br />Controlled Bum <br /> <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL ~ <br />Sprinkler D <br />Fire Alarm 0 <br />Hood Clean/Suppression 0 <br />Fire Alarm Installation <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />Other: <br /> <br />OTHER <br />Signature <br /> <br />Address I <br /> <br />Directions: <br /> <br />- <br /> <br />"'...&.~~ . <br /> <br />II <br /> <br />II <br /> <br />I Titleholder Phone Number I <br /> <br />I Lot# <br /> <br />Parcel # <br /> <br />I <br /> <br />lUO IAII'II:.U r-~UM l"'~Ul"'I:.~ I Y 1Ar.I'IU 11'-'1:.) <br /> <br />-, <br /> <br />EI Fumiyoliull T .."t <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 Re~eationalBum <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 />.1 Valuation of Project <br /> <br />Company I <br />Registered <br />License # I <br />Company I <br />Registered <br />License # I <br />Company I <br />Registered <br />License # <br />Company <br />Registered <br />License # <br />Company <br />Registered <br />License # <br /> <br />'sU'\"\ ~:;] k" G-, 111 {\.-e il <br />Y I N' Fee Current I Y I N <br /> <br />Y I N I Fee Current <br /> <br />Y/N <br /> <br />Y I N I Fee Current <br /> <br />Y/N <br /> <br />Y I N I Fee Current <br /> <br />Y/N <br /> <br />Y/N Fee Current Y/N I <br />~- ".,,-. . '~~ ~_'~"vm L <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 atter submittal date, <br />