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<br />.813-780-0020 <br /> <br />City of Zephyrhills Fire <br />Permit Application <br /> <br />Date Received <br />Wl' <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />Fee Simple Titleholder Name <br /> <br />Fee Simple Titleholder Address <br />Illllll!'!~WiAAjlI\'",_,Al.: WI~ 'n~ <br /> <br />I <br /> <br /> <br />Sub Division I <br />___ .,,' ; _1!l~li] <br /> <br />Fax-813-780-0021 <br /> <br /> <br />Phone Contact for Pennit <br /> <br />I ~/J <br />.j)S- <br /> <br />Titleholder Phone Number I <br /> <br />II I I I <br /> I <br />~"m'!ji.IJA ~ i ww. !IlJlIl!1 <br />I Lot # I I <br /> I <br /> <br />III JR.___,. <br /> <br /> <br />Job Address <br /> <br />11n rn <br /> <br />~___ llit___I''K) J <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br />Comm Exhaust Kitchen Hood/Duct <br />Controlled Bum <br /> <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 />Doooc=J <br />Doooc=J <br />Doooc=J <br /> <br />Fire Alann <br /> <br />Hood Cleaning <br /> <br />Hood Suppression <br /> <br />D Fire Alann Installation <br /> <br />~ Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />~ TO~"::;;" I !!:fffl}, ai~ <br /> <br /> <br />Contractor " 1M' <br />Signature ~ Ie Iff~ <br /> <br />Address ._ <br /> <br />i r <br /> <br />-~ <br /> <br /> <br />Parcel # <br /> <br />~1IIl <br /> <br />Fumigation Tent <br /> <br />Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> <br />Hood Installation <br /> <br />LP/Natural Gas-Installation <br />LP/Natural Gas-ANNUAL Sale <br />.Place~-ofAs;~;;bi~~ANNUAL <br /> <br />D <br />D <br />D <br />o <br />o <br /> <br />Recreational Bum <br /> <br />/ <br /> <br /> <br />Sparklers <br />Sprinkler System Install <br />Standpipes (Sprinkler Sys) <br />Torch Roofingrrar Kettle <br />Waste Tire Storage ANNUAL <br /> <br />Valuation of Project <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />ELECTRICIANI Company <br />Signature Registered <br />Address I License # <br />PLUMBER I Company <br />Signature Registered <br />Address I License # <br />MECHANICALI Company <br />Signature Registered <br />Address I License # <br />OTHER Company <br />Signature Registered <br /> License # <br /> <br />~~Yrn;t_. <br /> <br />f{~~ <br /> <br />) <br />Va'f~ <br /> <br />I <br />- <br /> <br />I <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Y I N Fee Current <br /> <br />Y I N I Fee Current <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Y I N Fee Current <br /> <br />Y/N <br /> <br />Y I N Fee Current <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.pas,c:og,~l';90~), <br /> <br />'. <br /> <br />""~'~ _:~~~,'~'.j' r~~~~::~,I.~~~,',\. <br />. . 'J>" ....... ~, Lt ~"",,; <br />';::,"'.. ~,~~.. -t.".,:,.~\, ~' <br />" ;=:!;,!~........" hI <br />