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<br />Date Received <br /> <br />I <br />~~\ ) ,1 )CA.. <br />I ,~ Ave, <br /> <br />City of Zephyrhills Fire <br />Permit Application <br /> <br />Phone Contact for Permit <br /> <br />tt1112'~13-780-0021 <br />II II I <br />11'1'?i'd 114~4J <br />I <br />I <br />I <br /> <br />II <br /> <br />II <br /> <br />813-780-0020 <br /> <br />I <br />I <br />~.- I~ <br /> <br />Fee Slmpie Titleholder Name <br /> <br />Owner's Name <br /> <br />I Owner's Phone Number <br /> <br />I <br />I~L3 <br /> <br />2~~\l)..Jl <br /> <br />TitIehokIer Phone Number <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />I <br />!3CCO <br />I <br /> <br />u~ Av-e... <br /> <br />~~ L~ ,-ft. I Lot# <br />I ~# I <br />(06IAINt::D FROM PKOt'I:RIY lAX NOIICl::) <br /> <br />Sub Division <br /> <br />D Bio-Hazard Waste Storage - ANNUAL <br />D Comm Exhaust Kitchen HoodIDuct <br />D Controlled Bum <br />D Emergency Generator < 30 kw <br />D Emergency Generator> 30 kw <br />~ Fire Protection Maintenance - ANNUAL <br />Sprinkler D <br />Fire Alann D <br />Hood CleanlSuppression 0" <br />D Fire Alann Installation <br />o Fire Pumps <br />o Fire Works <br />o Flammable Application- ANNUAL <br />D Fuel Tanks <br />o Other. <br /> <br />D Fumigation Tent <br />D Hazardous MaterIal (Tier II or RQ Facility) ANMJAL <br />D Hood Installation W'\ , \ ClaQn <br />D LPlNatural Gas-lnstallation <br />D LPINaturaI Gas-ANNUAL Sale C0~ <br />D Places of Assembly-ANNUAL <br />D ReaeatIonal Bum ~ r (;)l~r08 <br />0 Sparlders <br />D Sprinkler System Installations <br />0 Standpipes (Sprinkler Sys) <br />D Torch Roofing <br />0 Waste TIfe Storage ANNUAL <br /> <br />I Valuation of Project <br /> <br />Contractorj~ . ~ __ <br />Signature A--t ,........... L--=-- <br /> <br />Add II f'ernn('t'"J IV$Q <br /> <br />ELECTRICIANI <br />Signature . <br /> <br />Address I <br /> <br />PLUMBER I <br />Signature <br /> <br />Address I <br /> <br />MECHANICAL I <br />Signature . <br /> <br />Address I <br /> <br />I <br /> <br />()c" ,^, ,aJQ <br /> <br />~ ~c:;. L-l-c. <br />l. YJI N I Fee Cu~ Y I N I <br />I <br /> <br />Y/N I FeeCurrent I Y/N I <br />I <br /> <br />Y/N I FeeCunent I Y/N' <br />I <br /> <br />Y/N I FeeCurrent I Y/N I <br />I <br /> <br />Y/N , FeeCunent I Y/N' <br />I <br /> <br />Of <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />OTHER <br />Signature <br /> <br />Address I <br /> <br />Directions: <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) seIs of drawings with applicable documentation <br />Allow 10-14 days for review after submittal date. <br />