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<br />813-780-0020 City of Zephyr hills Fire ~1 ~Jf6 Fax-813-780-0021 <br />Permit \A.pplication <br /> <br />ii~:~~:~~~'}llifillwmmJ",~~!L]~Le,~_tm.L_f,t0Jj_'fillm:__L~~~~=_l~,!~t"lli~,zll=IL~ <br />I ' fJ ~ S~ fA~ I Owne~s Phone Number I II II I <br />I '-(310 '20'n.. ~+ Yf'A y~ I {~. K. I <br /> <br />, <br /> <br />I I Titleholder Phone Number II 1"1 I <br /> <br />I I <br />L:i3JO <br />I <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />Fee Simple Titleholder Name <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />2-Qfr. <br /> <br />s-:r <br /> <br />#!f,,'t./J/~~/ {s <br />I <br /> <br />Sub Division <br /> <br />Parcel # <br /> <br />(Uti I AINt:U I-KUM t-'KUt-'t:K I Y I AX NU 11L;t:) <br /> <br />I Lot# <br /> <br />o Bio-Hazard Waste Storage - ANNUAL <br />o Comm Exhaust Kitchen Hood/Duct <br />o Controlled Bum <br />o Emergency Generator < 30 kw <br />o Emergency Generator> 30 kw <br />o Fire Protection Maintenance - ANNUAL <br />Sprinkler D <br />Fire Alarm ~ <br />Hood Clean/Suppression D <br />o Fire Alarm Installation <br />o Fire Pumps <br />o Fire Works <br />D Flammable Application- ANNUAL <br /> <br />D Fuel Tanks <br />o Other: <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 /> 6- c"" <br />D Places of Assembly-ANNUAL NO eV,J;u..; <br />D Recreational Bum \l,U-r<' <br />~~e, <br />D Sparklers <br />D Sprinkler System Installations <br />D Standpipes (Sprinkler Sys) <br />D Torch Roofing <br />D Waste Tire Storage ANNUAL <br />I ;14 0C5D Valuation of Project LeL <br /> ~,:; <br /> <br /> <br /> <br />~-"'., <br />Contractor <br />Signature <br />Address <br />ELECTRICIANI <br />Signature . <br />Address I <br />PLUMBER <br />Signature <br />Address I <br />MECHANICALI <br />Signature . <br />Address I <br />OTHER <br />Signature <br />Address <br /> <br /> Company <br /> Registered <br /> License # <br /> I Company <br /> Registered <br />I I License # <br /> , Company <br /> Registered <br /> I License # <br />I I Company <br /> Registered <br /> I License # <br />! I Company <br /> Registered <br /> License # <br /> <br />~ I,s,., r L.6'( aM JI/ ,4;t-7L- <br />Y I N I Fee Current I Y I N <br /> <br />I'!' F ODD! 2-11 <br />, <br /> <br />Y I N I Fee Current <br /> <br />Y/N <br /> <br />Y / N I Fee Current <br /> <br />Y/N <br /> <br />Y IN' Fee Current <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Directions: <br /> <br />Fill out application completely. I <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. <br />