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<br />B13-780-0020 <br /> <br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />Fax-813-780-0021 <br /> <br />City of.Zephyrhi/ls Fire <br />.Permit Application <br /> <br />Phone Contact for Pennit <br /> <br /> <br />I~\c~ g~\ (eo? <br />i 63dl (-TC1 \I <br />I <br />I <br /> <br />5l\..J~ <br /> <br />Fee Simplel Titleholder Name <br /> <br />n~~'-~T~lIIF-"""!I~[l2Wi-=--~'t; <br /> <br /> <br />I J <br /> <br />II <br /> <br />Owner's Phone Number <br /> <br />II <br /> <br />II <br /> <br />I Titleholder Phone Number I <br /> <br />Fee Simplel Titleholder Address <br /> <br />:~=~:~'m"-j;:;;;' <br /> <br />Sub Division <br /> <br />e~l'IY-W""'V; "'=r.=.:.....~il"".I1"'.!..m <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />&~ ~j) 8 ~r\ <br /> <br />r~ <br /> <br />o <br />o <br />o <br />o <br />o <br />o <br />o <br />D <br />D <br />D <br />o <br />o <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br /> <br />Comm Exhaust Kitchen HoodlDuct <br /> <br />Controlled Bum <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 />Fire Pumps <br /> <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />~~~( ,:=::~o:~t: <br /> <br /> <br />.....f':f' ...............~m <br /> <br />I AA /'IIU II,-,t:) <br />~f1~~~-rml--w- -Rl <br /> <br />Fumigation Tent <br />Hazardous Material (Tier II or RQ Facility) ANNUAL <br />Hood Installation <br />LP/Natural Gas-Installation <br /> <br />LP/Natural Gas-ANNUAL Sale <br />Places of Assembly-ANNUAL <br /> <br />~d>- <br />\ 2--(30(07 <br /> <br />Recreational Bum <br /> <br />Sparklers <br />Sprinkler System Installations <br />Standpipes (Sprinkler Sys) <br />Torch Roofing <br />Waste Tire Storage ANNUAL <br /> <br />Other: <br /> <br />Valuation of Project <br /> <br /> <br />Contractor <br />Signature <br /> <br />Address I 1.\ \ Di <br /> <br />ELECTRICIAN <br />Signature I <br /> <br />Address I <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />~ECHANICALI <br />Signature . <br /> <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />~u...~ l eAJ <br /> <br />~bt..sc... M <br /> <br />~:"'ct~;;~J, ".." . __'rl.~., ~"""'_. '.-'.'=.. ~-- .. .~~ . "...... ,.' . .~=._,,_-L <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 /> <br />Company <br />Registered <br /> <br />License # <br /> <br />IbCP:f-a ()~ <br />Y I N Fee Current Y I N <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Company <br />Registered <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Company <br />Registered <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y I N I <br /> <br />License # J <br />- - . ''''''''''''_d''''=~l<<'~~;Oa,a.;';y"""",,,,,,,,,,,,.,,,.,," ._, <br /> <br />.' .__="""""'c.i~ ,......."".. ,.........;..,.,_~.:m,."""'""Lal<i!~=H!!I......................=' <br />