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<br />I I <br /> <br />: ~~Pl )~'~V~ <br /> <br />Fee Simpie Titleholder Name I <br />I <br /> <br />! 3&::n ) ~ Av~ <br />I <br /> <br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />813-780-0020 <br /> <br />it~8y <br /> <br />Phone Contact for Permit I II II <br /> <br />_-~ ()wno(s""""N~:- ~:3 I :7~dl :lfo91 <br />2_p\1 II f h.i1/~ J== : : <br />I Titleholder Phone Number I II II <br /> <br />City of Zephyrhills Fire <br />Permit Application <br /> <br />Fax-813-780-0021 <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />~j~% <br /> <br />ELECTRICIANI <br />Signature . <br /> <br />Address I <br /> <br />PLUMBER I <br /> <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br /> <br />Signature <br /> <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />Address I <br /> <br />Directions: <br /> <br />o <br />o <br />o <br />o <br />o <br />C$l <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br /> <br />Comm Exhaust Kitchen Hood/Duct <br /> <br />Controlled Bum <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />Sprinkler D <br />Fire Alarm D <br />Hood Clean/Suppression 00 <br />Fire Alarm Installation <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />zP~l h"\)15 ,f{ <br /> <br />I Parcel # I <br />(01:11 AINt:U HtOM I'KOI't:K' Y lAX NO 11(;t:) <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 />D Recreational Bum <br />D Sparklers <br />D Sprinkler System Installations <br />D Standpipes (Sprinkler Sys) <br />D Torch Roofing <br />D Waste Tire Storage ANNUAL <br /> <br />o <br />o <br />o <br />D <br />D <br />o <br /> <br />Fuel Tanks <br /> <br />I Lot# <br /> <br />w'\ \) tl20Yl <br />en W~d, <br />,- JUyo8 <br /> <br />~ Valuation of Project <br /> <br />Other: <br /> <br />U(l{",l <br />3Y-180Company <br />Registered <br /> <br />~ <br />~E t.J;)r:-ld (f. <br /> <br />Company <br />Registered <br /> <br />~,rJ /~C~~ EJ:L <br />Fee Current Y I N <br /> <br />I <br /> <br />License # <br /> <br />License # <br /> <br />Y/N I FeeCurrent I Y/N I <br />I <br /> <br />Y/N I FeeCurrent Y/N I <br />l <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />Y/N I Fee Current I Y/N I <br />I <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y I N I Fee Current I Y I N I <br />I <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. <br />