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<br />h;:;~;C::'LL'~ - - I ::,~:::~::" 'r~8.,~!, <br /> <br />fW P/LrlY>e'r3),V> LL c;t':>"-J".J. Get/! 15/J/.J,f .z-t'0A;~ <br /> <br />I Titleholder Phone Number I II II <br /> <br />813-780-0020 <br /> <br />Date Received <br /> <br />OWner's Name <br /> <br />Owner's Address <br /> <br />Fee Simple Titleholder Name <br /> <br />City of -Zephyr hills Fire <br />Permit Application <br /> <br />I eft> s-CIP/r:z= <br />I <br />I <br />r 73;;<~ ~ &vc.Q <br />I <br /> <br />Fee Simple Titleholder Address <br /> <br />D Fire Alarm Installation <br />D Fire Pumps <br />D Fire Works <br />D Flammable Application- ANNUAL <br />D Fuel Tanks <br />o Other: I <br /> <br />:0;:' I~ ~~ I <br /> <br />Md~' i5tf71 ).v' J1/~ tJ..ve. 71~ rL :H/,l" <br />ELECTRICIAN <br />Signature <br />Address I I <br /> <br />I <br />I <br />I <br />I <br />I <br /> <br /> <br />Sub Division <br /> <br />___IIIlI''''''- <br /> <br />o <br />o <br />D <br />o <br />o <br />~ <br /> <br />PLUMBER <br /> <br />Signature <br /> <br />Address I <br /> <br />MECHANIC4 <br />Signature . <br /> <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />(~a-~ <br /> <br />I Parcel # <br /> <br /> <br />o Fumigation Tent <br />o Hazardous Material (Tier 1\ or RQ Facility) ANNUAL <br />o Hood Installation <br />o LP/Natural Gas-Installation <br />o LP/Natural Gas-ANNUAL Sale <br />o Places of Assembly-ANNUAL <br />o Recreational Bum <br />o Sparklers <br />o Sprinkler System Installations <br />D Standpipes (Sprinkler Sys) <br />D Torch Roofing <br />o Waste Tire Storage ANNUAL <br /> <br />I <br /> <br />w.tl3ml'" <br /> <br />Fax-813-780-0021 <br /> <br />Ill'" <br /> <br />r)w)""'F~~~ltl""'..,n <br /> <br />u.i~!fi.~~ <br /> <br />I <br /> <br />~ ~ II <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br />Comm Exhaust Kitchen Hood/Duct <br />Controlled Bum <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br /> <br />Sprinkler <br />Fire Alarm <br /> <br />D <br />tZl <br />D <br /> <br />I Lot# <br /> <br />I <br /> <br />{UtjIAII'lt;U rKUIVI t"KUt"t:K~2 I~UII~~) <br />J_ _~~lJ.~W' ~1 r~:R'if - -~.. J-<~ <br /> <br />Hood Clean/Suppression <br /> <br />Valuation of Project <br /> <br />-...,,,,. Ii. <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />J.U'u <br /> <br />j" Y I N I Fee Current <br />I ~ F (!:r!>CJ/) ~ ~ <br /> <br />I Y IN <br />I <br /> <br />I Y IN <br />I <br /> <br />I Y I N I Fee Current <br />I <br /> <br />I Y/N <br /> <br />Y/N <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Company <br />Registered <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />License # <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 />