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Fax-813-780-0021
<br /> a�saao-oozo City of Zephyrhills Fire
<br /> Permit Application
<br /> — �'�'1 Phone Contact for Pertnit � �� • �
<br /> Date Received � ,.. . < �. _...,, ._�. , � _... _ _. . ._.:< .,.. ;m � : ,...;- , ; .., .. . . .,
<br /> _ . .. , �..:.r:s .. . __ � r_� ��
<br /> Owner's Phone Number �___
<br /> Owner's Name
<br /> Owner's Address c7 ! �\ ` ^ `
<br /> Titleholder Phone Number � �� ��
<br /> Fee Simple Titleholder Name
<br /> Fee SimpleTitleholder Address � >,.: t �;�;,, _ � -- •�� �=�• w• °� �
<br /> . ..-sa� � 4^, .;.
<br /> . , � �~. � '� Lot #
<br /> Job Address _ ,�,'O ��'
<br /> Parcel # — ' _ _
<br /> SubDivision a�.�..-�:: �°.:� �_�,. ..::,� ,......,...:�;--,�..r,,. ���°::.:r�;::: _. .. '�:� h m.. �.a_ ....,.,.. ..........�.
<br /> .� _,. ... ..,... .�s :, �:: '»^ s,^.:^��':�.�-�w.,� >.�.;m.u• ._�.;. �°� �. ",.s�' .,..� .... :. . ,..,� - r . . ,,. . ..,
<br /> �� Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent
<br /> � Comm Exhaust Kitchen HoodlDuct � Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> � Controlled Bum � Hood Installation
<br /> � � LP/Naturel Gas-Installation
<br /> Emergency Generator < 30 kw �
<br /> � LP/Natural Gas-ANNUAL Sale
<br /> Emergency Generator > 30 kw � /� �_ / `�
<br /> a Places of Assembly-ANNUAL u �
<br /> Fire Protection Maintenance - ANNUAL � �
<br /> r y emi � er �
<br /> Sprinkler � ❑ ❑ �� Recreational Bum
<br /> � � � � � Sparklers
<br /> Fire Alarm � �
<br /> Hood Cleaning � ❑ ❑ ❑ Sprinkler System Installations
<br /> Hood Suppression � � � �
<br /> � � Standpipes (Sprinkler Sys)
<br /> � Fire Alarm Instaltation � Torch Roofing/Tar Kettle
<br /> � � Waste Tire Storage ANNUAL
<br /> Fire Pumps
<br /> � Fire Works
<br /> � Valuation of Project
<br /> Flammable Application- ANNUAL
<br /> � Fuel Tanks
<br /> � Other. . , �_. .. � .�. F .. .... .......w._.. .....,:�.:::�: -g=:�e-�..,:�:•:� �- ..,..... .,..�.. �tw........_.
<br /> ,. ,; . < ; ,. . .. ..._ a� u. _ � ... . ,�.
<br /> ... ,>• _�. F <»...
<br /> °,.. _. . ,_. . _ . ,.._. ,. , Company .
<br /> Contractor
<br /> Registered / Fee Curcent
<br /> Signature
<br /> License #
<br /> Address
<br /> ELECTRICIAN Company
<br /> Registered Y/ N Fee Current Y/ N
<br /> Signature
<br /> License #
<br /> Address
<br /> PLUMBER Company
<br /> Registered Y/ N Fee Current Y/ N
<br /> Signature
<br /> License #
<br /> Address
<br /> MECHANICAL Company
<br /> Registered Y/ N Fee Current Y/ N
<br /> Signature
<br /> License #
<br /> Address
<br /> OTHER Company
<br /> Registered Y/ N Fee Current Y/ N
<br /> Signature
<br /> Address License # . ,..,�..n , -�,
<br /> r�c�< .., ._.�. _.aW �. _ �. ... _. _ ........_ ....,_ ..�.... .�.. .._._ _,..y_x.>__.«.....�... ..... >..w-_�.,.....�_.�.....�. .. _ ,_.� �.>_. ,. _._....... �....... �
<br /> Direclions:
<br /> Fill out application completely
<br /> Owner & Contractor sign back of application, notarized (Or, copy of sig�ed 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 P y � P: PP P 9 �
<br /> Allow 10-'14 days for review after submittal date. Parcel #- obtained from Pro ert Tax Notice htt //a raiser. asco ov.com
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