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<br />813-780-0020 <br /> <br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />City of Zephyrhills Fire <br />Permit Application <br /> <br /> <br />Fee Simple Titleholder Name <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />Fax-813-780-0021 <br /> <br /> <br />Phone Contact for Pennit <br /> <br />I f3IJ II /80 1122.h ~I <br /> <br />Titleholder Phone Number <br /> <br />II <br /> <br />II <br /> <br />o <br />o <br />o <br />o <br />o <br />o <br /> <br />Bic-Hazard Waste Storage - ANNUAL <br />Comm Exhaust Kitchen Hood/Duct <br />Controlled Bum <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 /> <br />Fire Alann D 0 0 0 c=J <br /> <br />Hood Cleaning D 0 0 0 c=J <br /> <br />Hood Suppression ~ 0 K 0 c=J <br /> <br />Fire Alann Installation <br /> <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />Other: <br /> <br />Lot # <br /> <br />I <br /> <br />o <br />o <br />D <br />B <br />o <br /> <br />Parcel # <br /> <br />D Fumigation Tent <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 /> <br />D Recreational Bum <br />D Sparklers <br />D Sprinkler System Installations <br />D Standpipes (Sprinkler Sys) <br />D Torch RoofingfTar Kettle <br />D Waste Tire Storage ANNUAL <br /> <br />Valuation of Project <br /> <br />(! <br />6/"'1rl/t. e /l. c:...t.t<T' ( <br /> <br />H""l.1.. <br /> <br />Contractor <br />Signature <br />Address I <br />ELECTRICIANI <br />Signature <br />Address I <br /> <br />PLUMBER <br />Signature <br />Address I <br />MECHANICALI <br />Signature . <br />Address I <br />OTHER <br /> <br />Y I N I <br />I <br />& fR.. [~ I Company ~ d1 <br />Registered Y Y N I Fee Current I Y N I <br /> <br />*"C2!t!::Vi_.tMN=~_.~JM__~~,;~~~~~L~^~^r~,~29f2~2! ~LLLa-_~fJll.' <br /> <br />Signature <br />..Ad~re~sJ/o.<?t:, R<:Vt'/[ /f~l. <br />@,%b1h%m~~[~l:m$dttl@Ji~lt%~,~:''{i\~i<~;\~:,,,,;;::ici,,,*-~~~':~~'$.W.4'''',j;;J~M.~~~~:w:",*~:,_~*j,M."it,"*j:.\i:::idMj..(;H~~*~,*~i!h <br />Directions: <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />License # <br /> <br />Fill out application completeiy. <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 />