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<br />813-780-0020 <br /> <br />City of Zephyrhills Fire <br />Permit Application <br /> <br />Fax-813-780-0021 <br /> <br />Phorie Contact for Permit <br /> <br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />btJD6 <'=? Owner's Phone Number : I II <br />I I II <br />Titleholder Phone Number II <br />,,~ <br />~~~ <br /> <br />p-~v,e".>.I<<$ ~J<J"I /<0- <br /> <br />I <br />I <br />15~'5'D <br /> <br />Fee Simple Titleholder Name <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />/ c:::: T~ <br /> <br />.s;7 ?P-G') <br />I <br /> <br />Parcel # <br /> <br />I Lot# <br /> <br />Sub Division <br /> <br />Contractor <br />Signature <br /> <br />Address I <br /> <br />ELECTRICIANI <br /> <br />Signature <br /> <br />Address I <br /> <br />PLUMBER <br /> <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br /> <br />Signature <br /> <br />Address I <br /> <br />OTHER <br /> <br />Signature <br /> <br />Address <br />-- <br />Directions: <br /> <br />o <br />o <br />o <br />o <br />o <br />o <br /> <br />o <br />o <br />D <br />D <br />D <br />o <br />D <br />D <br />D <br />D <br />D <br />o <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 />Torch RoofingfTar Kettle <br />Waste Tire Storage ANNUAL <br /> <br />Valuation of Project <br /> <br />Company <br /> <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 /> <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />~M:i~=Y~~~~ <br /> <br />I <br />2 <br /> <br /> <br />~ <br />o <br />I <br /> <br />Bio-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 Alarm D 0 0 0 c=J <br /> <br />- Hood Cleaning @ 0 0 ~ <br /> <br />Hood Suppression I2::J 0 ~ 0 c=J <br /> <br />Fire Alarm Installation <br /> <br />Fire Pumps <br />Fire Works <br />Flammable AppJication- ANNUAL <br /> <br />Fuel Tanks <br /> <br />Other: <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <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 />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />$cV~ n~C:f <br />7 N ee Current Y / N I <br /> <br />J5:Q~_~~~~~,~, <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 />