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<br />OCCUPANCY NO.: <br /> <br />CITY OF ZEPHYRHILLS <br />FIRE RESCUE <br />INSPECTION DEPARTMENT <br />6907 DAIRY ROAD <br />ZEPHYRHILLS, FL 33542 <br />(813) 780-0035 <br />Administration: (813) 780-0041 <br /> <br />******************************************************************************************************************* <br /> <br /> FIRE SAFETY INSPECTION <br /> '-r I . ~, <br />Business Name: ,) \, -,) r;:> ':'.," Business Owner: <br /> :, \ I i <br /> V ~/ ,/ <br />Building Name: Telephone: <br />Street Address: '"') ! ( Building Owner: <br />Suite: Telephone: <br />City: Zip -~) ') '" '-/'(, Emergency Contact # 1 : <br />Manager: Telephone: <br /> ? : // <br />Telephone: " -' Emergency Contact #2: <br />Occupant Type: Telephone: <br /> <br />******************************************************************************************************************* <br /> <br />TYPE OF INSPECTION CONDUCTED <br /> <br />Annual: <br /> <br />Reinspection: <br /> <br />Commercial: <br /> <br />Code Violation: <br /> <br />Qtly: <br /> <br />Fire Protection: <br /> <br />Sprinkler: <br /> <br />Gas: <br /> <br />Suppression: __ <br /> <br />Other: / <br /> <br />',rL_ <br /> <br />Approved: ~,. <br /> <br />Conditionally Approved: _ <br /> <br />Not Approved: _ <br /> <br />******************************************************************************************************************* <br /> <br />Comments: <br /> <br />'1/ <br />'J if <br /> <br />/ //( <br />./ <br /> <br />/;;; <br /> <br />,.I// <br />../. / / <br /> <br />/ <br />/' ,1-/7 <br />, <br /> <br />, , <br /><~/~/<,> /'.s ? <br /> <br />// <br />/ <br />;...... . ,/ <' <br /> <br />t:"/ ~-/ <br /> <br />,." /" <br /> <br />/",/ ,.." <br />L;:;- <br /> <br />,'//<- <br /> <br />~" (- <br />- > <br /> <br />/ <br /> <br />/,./ <br />/J <br /> <br />/ <br />c- {-'I C, j <br /> <br />./,/~ <br /> <br /> <br />i. <br /> <br />-' ...",-~ <br /> <br />. to t-":' /" ~/'/ ,:-F <br /> <br />...-: ,J' <br /> <br />, r?/' ./ .r <br /> <br />, <br />t <br /> <br /><.~.::.- <br /> <br />~ <br /> <br />iJ ~~ <br /> <br />/ <br />/ <br /> <br />"", ( <br /> <br />(~... <br />,,"( '~'t <br /> <br />****************************************************************************************************************** <br /> <br />This building had been assessed by the Zephyrhills Fire Department. Utilizing the Codes and Standards of, NFPA Minimum Standards, the <br />State Fire Marshal Uniform Fire Safety Rules and other local fire safety codes. <br /> <br />Code violations specified in this report, if not corrected could cause or contribute to the spread of fire, or prevent safe egress during fire. Your <br />immediate attention to the correction of these violations shall be required, failure to comply is a violation of the City of Zephyrhills Fire <br />Prevention Code. <br /> <br />, I <br />*********************jf******************************************************************************************** <br /> <br />Inspection Date: ,,".' i'l' l 1/ Re-Inspection Date: <br /> <br />Inspector Name: (Print) i I I <' ) J " //1 Inspector LD.#: <br />/_,~~~..\..~,:_,.. <br /> <br />Inspector Signature: <br /> <br />Occupancy Representative <br />Signature: <br /> <br />Computer Entry: <br /> <br />Title: <br /> <br />Pre-Fire Plan on File: <br /> <br />Page <br /> <br />of <br /> <br />Revised 04/04 <br />