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<br />813-780-0020 <br /> <br />City of Zephyrhills 'Fire. <br />Permit Application <br /> <br />Date Receive,Sl , <br />~1- <br /> <br />IIfll,L_-....."" ,.~" J <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />I <br /> <br />Fee Simple Titleholder Address I <br /> <br />tR:lt1! lr ,.~~ ~G~ !mmR,_JJW~~~;~>,.,,-.4.U <br /> <br />,350 N. Dci\t,j <br /> <br />Fee Simple Titleholder Name <br /> <br />rt' <o~)~S <br /> <br />I <br /> <br />Pho~e Contact for Permit j ....l! ~ <br />_ ,~~. _, ':#i'$il~ ~r <br /> <br />Fax-813-780-0021 <br /> <br />U~~,llL~..u/...J <br />II II I <br />I <br />I <br />~:iltTW <br /> <br />I <br />I <br /> <br />Owner's Phone Number <br /> <br />'I <br /> <br />Titleholder Phone Number I <br /> <br />II <br /> <br />II <br /> <br />il~~!:iiJ <br /> <br />z(e~~:'~~:~lr:-l ~~~~ <br />D <br />D <br />D Hood Installation <br />D LP/Natural Gas-Installation <br />D <br />D <br /> <br />D Recreational Bum <br />D Sparklers <br />D Sprinkler System Installations <br />D Standpipes (Sprinkler Sys) <br />D Torch RoofingfTar Kettle <br />D Waste Tire Storage ANNUAL <br /> <br />Job Address <br /> <br />- ~d~1 <br /> <br />Sub Division <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 />rY1';:1 I~~mq IA~II 0 <br />Do DOc=] <br />Do DOc=] <br />Do 0 dc=] <br /> <br />Sprinkler <br /> <br />Fire Alarm <br /> <br />Hood Cleaning <br /> <br />Hood Suppression <br /> <br />Contractor <br />Signature <br />Address <br /> <br /> <br />e.-P <br /> <br />Fire Alarm Installation <br /> <br />Fire Pumps <br /> <br />Fire Works <br /> <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />Other: <br /> <br /> <br />ELECTRICIANI <br />Signature . <br /> <br />Address I <br /> <br />PLUMBER I <br /> <br />Signature <br />Address I <br />MECHANICALI <br />Signature <br />Address I <br /> <br />OTHER <br /> <br />Signature <br /> <br />Address <br /> <br />Directions: <br /> <br />"U'l.I~'''.~_Ch <br /> <br />I Lot# <br /> <br />I <br /> <br />Fumigation Tent <br />Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> <br />LP/Natural Gas-ANNUAl- Sale <br />Places of Assembly-ANNUAL <br /> <br />,,(' ~)p~ <br />lfo,~" <br />(V\DJ \ '~n'fl' ~il' ~ <br />0~ ~~ {'VI <br />L(-1 tt .p '3 3t! { 0 <br /> <br />Valuation of Project <br /> <br />Company <br />Registered <br /> <br />license # <br /> <br />5,~p/~ ~ <br />Y IN I Fee Current Y I N <br /> <br />Company <br />Registered <br /> <br />Y/N <br /> <br />Y I N Fee Current <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y I N I Fee Current <br /> <br />Y/N <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Y I N Fee Current <br /> <br />Company <br />Registered <br /> <br />License # <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,pascogov.com) <br />