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<br />OCT/1'1/2007/THU 0 I: II PM <br /> <br />813.780-0020 <br /> <br />FAX No. 813-780-0021 q <br /> <br />City of.Zephyrhllls Fire ~ '71 b <br />Permit Application <br /> <br />ZEPHYRHILLS BUILDING <br /> <br />p, 00 I <br /> <br />Fax-813-780-0021 <br /> <br /> <br />Date Received 0 --- I ". 0 Phone Contact for Permit <br /> <br />Owner's Nama I r ffi r f{\(\ X-t 0 \- :::-nl ~a.y.e , \ nC I Owners PhOrlB Numher <br /> <br />o.ne<,Ad"." I ~\~ rf\lrkoJ ~ ~(e LQrh~rh"/lsr:L. <br /> <br />Fee SImple Titleholder Name I, : . _I TItleholder Phone Number <br />Fee Simple TItleholder Address I <br /> <br /> <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />~~ 1 btM <br /> <br />D <br />D <br />D <br />D <br />~ <br /> <br />D <br />D <br />.D <br />D <br />D <br />o <br /> <br />Contractor <br />'Signature <br /> <br />ELECTRICIA <br />Signature <br /> <br />Address I <br /> <br />I <br /> <br />PLUMBER <br /> <br />Signature <br /> <br />Addre5s I <br /> <br />MECHANICALI <br />Signature <br /> <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />[ <br /> <br />~~blU <br /> <br />~~>-' ~w I <br /> <br />mr--- <br /> <br />I /'1 <br />??:J5 LJ 2.. , <br />I " II <br /> <br />It <br /> <br />Blo-Hazard Waste Storage - ANNUAL <br />Comm Exhaust Kitchen HoodlDuct ' <br />Controlled Bum <br />, Emergency Generator <: 30 kw <br />Emergency Generator:> 30 kw <br />Fire Protection Malntanancs - ANNUAL <br />Sprinkler D <br />,Fire Alarm g <br />Hood Clean/Suppression 0 <br />Fire Alarm Installation <br /> <br />Fire'Pumps <br />Fire Works <br />Flammable Applicatlon- ANNUAL <br /> <br />Fuel Tank.. <br /> <br />II <br /> <br />~ <br /> <br />liJIIl .,. =-<II"~ [l ll~_...._......_JllJiII-Il.ll,1 -- <br /> <br />Parcel # <br /> <br />.......AIIm4tl <br /> <br />~~~ <br /> <br />D <br />o <br />D' Hood Installation <br />D LPlNatural Gas-Installation <br />D LPJNatural Gas-ANNUAl-Sale. <br />o Places of A5sembly-ANNUAL. <br />D Recreallonal Bum <br />D Sparklers <br />D Sprinkler System Installations <br />D Standpipes (Sprinkler Sys) <br />D Torch Roofing <br />D 'Waste Tire Storage ANNUAL <br /> <br />I <br /> <br />Fumigation Tent <br />Hazardous Material (Tier" arRQ Facility) ANNUAL <br /> <br />~ <br />P ~1/()"1 t'Pf' <br />IO~3 <br /> <br />1 <br /> <br />Valuation of Project <br /> <br />Company <br />Reglstered <br /> <br />~m ~FC i c" / Fr /'ce':i:C Oh'lM ,~. <br />J Y IN, F9flCumm[ ,1:Yl N I ' <br />IF.=F,oOOo 7~ I <br /> <br />J .y I N I Fee Current I Y IN' <br />I I <br /> <br />I, Y I N I Fee Current Y I N I <br />I <br /> <br />Y IN I <br />I <br /> <br />Licen..a # <br /> <br />C~mpany <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # 'I <br /> <br />Company I <br />Registered <br /> <br />LIcense # I <br /> <br />Company I <br />Registered . <br /> <br />Y1N r <br /> <br />Fee Current <br /> <br />Fee Current I Y I N I <br />~___ L~l 'dce~~# r;rL~, '~-_'oJ_;: \:~~, 1 <br /> <br />Y/N <br /> <br />~. ~ddr~-.u._~~_.....--.,,,~_':",, rr:lI--l'i-- <br />Directions: , <br />Fill out application completely. <br />Owner 0& COntractor sign back of application, notarized (Or. copy of signed oontractwith owner) <br />If over $2500, a Notice of Comrnancement 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 /> <br />lZ!lll:.ll>...1ft'I..dI><:\.___ <br />