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<br />. 813-7~0-0020 <br /> <br />Date Received <br /> <br />.'Iler's Name <br /> <br />Owner's Address <br /> <br />City of.Zephyrhills Fire <br />Permit Application <br /> <br />#.rgt31- <br /> <br />Fax-813-78D-0021 <br /> <br /> <br />7- 30- 0 Z' Phone Contact for Penn it <br /> <br /> <br />lJi""wVlV/eLV Rera.tI L L C Owner's Phone Number 1/)/:3 <br /> <br />S'Ct;/Tz. ~E Pc~;rD1et LLC r~Ct:JY)5/J(J' ~C e <br /> <br />~ ~lr <br />117$'.:3 119)"tf / <br />ol fA <br /> <br />Fee Simple Titleholder Name <br /> <br /> <br />I Titleholder Phone Number <br /> <br />II <br /> <br />II <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br /> <br /> <br />Parcel # <br /> <br />Lot # <br /> <br />1..:3..r~~S'~/-"D/t?-O !7c7/lIJ-Oc) / / <br />tUb I f\1I'11~U r-KUIVI t"KUt"~K I Y I f\A NU II~~) <br /> <br />D Fire Alann Installation <br />D Fire Pumps <br />D Fire Works <br />D Flammable Application- ANNUAL <br />c==J Fuel Tanks <br />D Other: I <br /> <br />~.~~ <br /> <br />D <br />D <br />D <br />o <br />D <br />D <br /> <br />Contractor <br />Signature <br /> <br />Address I <br /> <br />ELECTRICIAN <br />Signature <br /> <br />Address <br /> <br />PLUMBER <br />Signature <br /> <br />Address <br /> <br />MECHANiCAL! <br />Signature I <br /> <br />Address I <br /> <br />Controlled Bum <br /> <br />D <br />o <br />o <br />D <br />D <br />o <br />D 0 <br />~~tte'('fy 0 <br />D 0 <br />D <br />o <br />o <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br /> <br />Comm Exhaust Kitchen Hood/Duct <br /> <br />. Emergency Generator < 30 kw <br /> <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br /> <br />Sprinkler <br />Fire Alann <br /> <br />Hood Clean/Suppression <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 />Recreational Bum <br /> <br />Sparklers <br />Sprinkler System Installations <br />Standpipes (Sprinkler Sys) <br />Torch Roofing <br />Waste Tire Storage ANNUAL <br /> <br />Valuation of Project <br /> <br />.- <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />~e.ctlrITY5t~c.e~ <br />~ Fee Current _ N I <br />I <br /> <br />I <br />I <br /> <br />I <br />I <br /> <br />I <br />I <br /> <br />Y /N I <br />l <br /> <br />OTHER <br />Signature <br /> <br />Address I <br />, ...".""....:<i!<<<<w.. <br />Directions: <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 /> <br />Company <br />Registered <br /> <br />License # <br /> <br />I CP 1>0 t:!) I/O!. 3 <br />I Y/N I Fee Current I Y/N <br />I <br /> Y/N I Fee Current I Y/N <br /> Y/N I Fee Current I Y/N <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />Fee Current I <br /> <br />Y/N I <br /> <br />License # <br /> <br />_~_',v <br /> <br />,~'~~ <br />