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<br />813-780-0020 <br /> <br />. <br /> <br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />Fee Simple Titleholder Name <br /> <br />City of Zephyrhills Fire <br />Permit Application <br /> <br />~ <br />I ~:: _ t!,,,.,.,/ - Jarr .,- .-II I~ I OWneM''''' .ombe' 7 y3 <br />I lP_L Cs-~(( /.it t/# Z#~-I /J '3 3rt.( 2- <br />I I Titleholder Phone Number I <br />I <br /> <br /> <br />Fee Simple Titleholder Address <br /> <br />~0?V <br /> <br />Fax-813-780-0021 <br /> <br />Phone Contact for Pennit <br /> <br /> <br />Ilrr "9' I _I <br /> <br />II II <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />I Lot# <br /> <br />'<:6'~ ~II t3{ v4 <br /> <br />Parcel # <br /> <br />(U~ I AINt::U I-KUM I-'KUI-'t::K I Y I AX. NU 11\,;t::) <br /> <br />D <br />D <br />D <br />D <br />D <br />~ <br /> <br />D <br />D <br />D <br />o <br />o <br />D <br /> <br />OTHER <br />Signature <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br />Comm Exhaust Kitchen HoodlDuct <br />Controlled Bum <br /> <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />Sprinkler D <br />Fire Alann D <br />Hood Clean/Suppression ~ <br />Fire Alann Installation <br /> <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />o <br />o <br />o <br />o <br />o <br />o <br />o <br />o <br />o <br />o <br />o <br />o <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 />I .Jt70- <br /> <br />Valuation of Project <br /> <br />Other: <br /> <br />- <br /> <br />I <br /> <br />Company <br />Registered <br /> <br />h-r<- fl'-~fAe-- <br />Y I N Fee Current I Y I N <br /> <br />71"~ c(floeu') 7ft p, <br /> <br />C~ntractor ~_I_~_:mmm~_ - .1~ ~ ~ <br />Slgnature~ <br />Address I <9'.1Je:J /ltPt7\e R.4 tcA.J lJ'tc[e1 ']c.{'JCf <br /> <br />ELECTRICIANI <br />Signature . <br /> <br />Address I. <br /> <br />PLUMBER <br />Signature <br />Address I <br /> <br />MECHANICALI <br />Signature . <br /> <br />Address I <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 I N I Fee Current <br /> <br />Y/N <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 I N I Fee Current <br /> <br />Y/N <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. <br />