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<br />813-780-0020 <br /> <br />Date Received <br /> <br />City of Zephyrhills Fire <br />Permit Application <br /> <br />Fax-813-780-0021 <br /> <br /> <br />Owner's Name <br /> <br />NO A <br />p. o. tox <br /> <br />S7: CL6AJ.JHJ <br />4QC;6 TAmPA <br /> <br /> <br />Owner's Address <br /> <br />Fee Simple Titleholder Name <br />Fee Simple Titleholder Address <br /> <br />--~. <br /> <br />1IIl:i.__.I!t\W _k",.___i iih-., <br /> <br />Phone Contact for Permit <br /> <br />, Owner's Phone Number <br /> <br />181~ <br /> <br />11350 <br /> <br />Ilq350 I <br /> <br />""hold" Pho,," Numbo, ~ <br /> <br />II <br /> <br />II <br /> <br />~Mm i;jJ;; <br /> <br />Sub Division <br /> <br />S()..,"e~ WAL- AfAItT 76D/. GALL- l>[J,[..p.28P1l(1tJ~ 33S-4~ <br />I Parcel # <br /> <br />Lot# <br /> <br />D Fire Alarm Installation <br /> <br />~ Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />__~.l~~~,,~~IJIIJQ..:t'lu. l>e p~e l~ '!!w~l.!!;,!::!--'m" I..:. .. '>"~ffl'lf~UI''''!i <br /> <br />contractor! }, u- '.{)- ~ I Company I~OIA tesT Cl.EA~,t.I~ <br />Signature I re:.t.e.tJc:u Registered Y I N I Fee Current I <br />Address I P.O. !>o)<', </'1(;6 rAmP.A. ,Fl. 3367? I License # I <br />ELECTRICIANI j Company I <br />Signature . Registered Y I N I Fee Current <br />Address I , License # I <br /> <br />;~~~~~R I ~:;:t:~;d I Y I N I Fee Current <br /> <br />Address I I License # I <br /> <br />MECHANICALI I Company I <br />Signature , Registered Y I N <br /> <br />Address I I License # I <br /> <br />~i:~~:re I ~:;:t:~~d I Y I N <br /> <br />Job Address <br /> <br />D <br />D <br />D <br />D <br />D <br />D <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 0 0 0 0 L-.-l <br />0000c:=J <br />t8J)!l" 0 0 c:=J <br />0000c:=J <br /> <br />Fire Alarm <br /> <br />Hood Cleaning <br /> <br />Hood Suppression <br /> <br />Address <br />Directions: <br /> <br />o <br />o <br />o <br />o <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 />LP/Natural Gas-Installation <br />LP/Natural Gas-ANNUAL Sale <br />Places of Assembly-ANNUAL <br /> <br />Recreational Bum <br /> <br /> <br />Sparklers <br />Sprinkler System Installations <br />Standpipes (Sprinkler Sys) <br /> <br />Torch RoofingfTar Kettle <br />Waste Tire Storage ANNUAL <br /> <br />Valuation of Project <br /> <br />I <br />lLlr_i1i:,l..~ <br /> <br />lie . <br /> <br />~~Jcr J <br /> <br />I <br /> <br />Y IN I <br />I <br /> <br />Y IN I <br />I <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />License # <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. Parcel # _ obtained from Property Tax Notice (http://appralser.pascogov,com) <br />