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<br />813:r78D-DD2tJ <br /> <br />Date Received <br /> <br />City of Zephyr hills 'Fir-e <br />Permit Application <br /> <br />to Z1L( <br /> <br />Fax-813-780-0021 <br /> <br /> <br />J . I <br />'~'~"">"',~"''''''~';'M,:'''''~."~,,,",,,,:,, <br /> <br />I.] I <br /> <br />Phone Contact for Permit <br /> <br />Owner's Phone Number <br /> <br />"I <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br /> <br />" <br /> <br />II <br /> <br />I Titleholder Phone Number <br /> <br />I <br />I <br />:ik.'rJ1 s ,c~ <br /> <br />Fee Simple Titleholder Name <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />I Lot# <br /> <br />I <br /> <br />A~ <br /> <br />Parcel # <br /> <br />D Fire Alarm Installation <br /> <br />D <br />D <br />D Flammable Application- ANNUAL <br />D Fuel Tanks <br />o <br />iWJ>~~~~~-~ <br /> <br />I <br /> <br />Contractor <br />Signature <br />Address I <br />ELECTRICIANI <br />Signature <br />Address I <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br />Signature . <br /> <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />D <br />o <br />D <br />D <br />o <br />o <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 />[&] Places of Assembly-ANNUAL <br /> <br />D Recreational Bum <br />D Sparklers <br />D Sprinkler System Installations <br />D Standpipes (Sprinkler Sys) <br />D Torch Roofingrrar Kettle <br />D Waste Tire Storage ANNUAL <br /> <br />Bia-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 0 0 0 0 l.-J <br />Fire Alarm 0 0 0 0 c=I <br />Hood Cleaning 0 0 0 0 c=I <br />Hood Suppression 0 0 0 0 c=I <br /> <br />Fire Pumps <br />Fire Works <br /> <br />Valuation of Project <br /> <br />Other: <br /> <br />1ST l' <br /> <br />,!@ <br /> <br />'~lilHfi:f~~l'$i~~~~~~~" <br /> <br />~ <br /> <br />Company <br /> <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Company <br />Registered <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />License # <br /> <br />Company <br /> <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Address <br /> <br />Directions: <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 />