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<br />813-780-0020 <br /> <br />~ <br /> <br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />.. <br /> <br />City of Zephyrhills Fire. <br />Permit Application <br /> <br />Fax-813-780-0021 <br /> <br /> <br />Fee Simple Titleholder Name <br /> <br />I <br />'.~q 002 <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />Phone Contact for Permit <br /> <br /> <br />Owner's Phone Number <br /> <br />II II <br />II II <br />I Lot# I <br /> <br />'L-5 F?:53 Jf(} <br />Titleholder Phone Number I <br /> <br />'i+rn t<Jt.. t(~F' fA ~ <br /> <br />_ Parcel # <br /> <br />o Fire Alarm Installation <br /> <br /> <br />A F~IT,~ <br /> <br />D~l I <br />=-'-""'-"'_.__'~'_"~".u;_"'.,~' ",'~' , "","" -,,-."''','''__~ '~""'"'' ,_" .,~ ""'"'_P_"';_""rn'_'"_'~~'"U~'-''~_''''''___'''_W'~_'''''1iII__'''''W~"'_""_~""___",", <br />,~:::m">>>:~~~=~m==::;~OO!"""~~",, "_~. . -_~--~-=~~~~='"'~~=~~~~ "'<"'-O.="......~~M=~W.*=fu'=~f:lil',,= <br />Contractor I ,/ / "'. I Company I I <br />S',"RUM .. / C'?ff . Reg,"""". Y I N I F.. C"""'" I Y I N I <br /> <br />Address I I License # I I <br /> <br />ELECTRICIAN] I Company I <br />Signature , , Registered, Y I N Fee Current Y I N I <br /> <br />Address I I License # I I <br /> <br />;~~~~~R I ~:;:t::d I Y I N I Fee Current Y I N <br /> <br />Address I I License # I <br /> <br />~:~a~:~ICALI I ~:;:t::d I Y I N <br /> <br />Address I , License # I <br /> <br />~i:~~:re I ~:;:t::d I Y I N <br /> <br />o <br />o <br />o <br />o <br />o <br />o <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 D 0 0 0 L-J <br />Doooc:=J <br />Do ooc:=J <br />Doooc:=J <br /> <br />D <br />D <br />D <br />D <br />D <br />~ <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 />Sparklers <br />Sprinkler System Installations <br />Standpipes (Sprinkler Sys) <br /> <br />Torch RoofinglTar Kettle <br />Waste Tire Storage ANNUAL <br /> <br />Fire Alarm <br /> <br />Hood Cleaning <br /> <br />Hood Suppression <br /> <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Valuation of Project <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Address <br />Directions: <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://appraiser.pascogov,com) <br />