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<br />n!;( 1 ~ <br /> <br />nnl/ /'VD T <br /> <br />€113-7SIJ-0020 <br /> <br />Date Received <br />.v <br /> <br />Owner's Nflme <br /> <br />Owner's Ad,dress <br /> <br />City of.Zephyrhllls Fire <br />Psrmit Application <br />PhonlilCantact tor Permit 1 ~~r~ U'Z~~ J.l4~t,7 <br />01Ml8r'S Phone Number I it] 1l7(.f"s 1./ S.96 (7' <br /> <br />\ 1 , c: '7 ,J" U <br /> <br />ZEPHYRHILLS BUILDING <br /> <br />! "2 -' ~~ - J'-L1'~' <br />r 1 1 r~tv!::..-... r&t C'. ~...~... l 1 <br /> <br />'1 J)Auin /Lr/tt.e-- <br />~ 6u/1 fJlV) L7/t-t//r-, ~ <br />. , <br /> <br />I <br />I <br />I 06.55 .6c1/ 6/v~/ <br />I~~. l <br /> <br />fee Simple Titleholder Name <br /> <br />File Simple Titleholder Address <br />i <br /> <br />Job Addres:s <br /> <br />Sub Divisloil <br /> <br />:; <br /> <br />,- <br />.' C', <br /> <br />:." :-/,:-..-,-,'-,;-,.-" <br />- - -........ ~ <br /> <br />[w <br />J <br /> <br />Fax-813--780.0021 <br /> <br />Till <br /> <br />JYS'7j <br /> <br />I Titleholder Phone Number <br /> <br />I'C <br /> <br />II <br /> <br />Bio--Hanld Waste Stoll!lge - ANNUAL <br />Camm Exhaust Kitchen HOodlDuct <br />Controll$d Bum <br />. Emergency Genellltor < 30 I<w <br />Emergency Generator:> 30 kw <br />. Fire Protection Mein.tenance - ANNUAL <br />Sprinkler 0 <br />Fjre Alarm . D " <br />Hood Clean/Suppression ~ <br />fIre Alarm Installation <br />Fire Pumps <br />Are Works <br />Aammable Application- ANNUAl.. <br /> <br />Fuel Tankli <br /> <br />Other: <br /> <br />:r <br /> <br />Q-" <br /> <br />/n <br /> <br />Ot<:.of' <br /> <br />/lY..-- {I"fr"~d ,( <br /> <br />Parcel # <br /> <br />, <br /> <br />jLot# C <br /> <br /> <br />t {va' I A1Nt;;L.J "'f'lulvJI"f'lvt"t:I'( I T IJV\ NV ll~t;;} <br /> <br /> <br />l*r"'I <br /> <br />D <br />o <br />D <br />D <br />D <br />D <br /> <br />D <br />o <br />o <br />o <br />o <br />D <br /> <br />Contractor <br />Signature <br /> <br />Addr~$ <br /> <br />eLECTRICIAN <br />Signature <br /> <br />Addrfi6 I <br /> <br />PLUMBER I <br />Signature ' . <br /> <br />Address "I <br /> <br />MECHANlCAi <br />. SIgnature ' <br /> <br />Address I <br /> <br />OTHER I <br />Signature <br /> <br />. jddress ! ,~.~~. <br />Dire ons: <br />Fill out application comPletely, . . <br />OWner & CorrIrBotor sign back of l!IppllClt'ltion. 'mrtiuizod (Or, copy c.rf signed contract with owner) <br />If over $2~OO. B Notice of Commencement is requlrud (Ml!lchanioal wor1c over iCiOOO) <br />Supply two (2) sets of drawlng5 ,'Ntlh applicable documentation <br />Allow 10-14 dOly& for review aft.,- 5ubmlttal date. <br /> <br />DEC-14-20E17 FRI 10: 34AM 1D: <br /> <br />Fumigation Tent <br />Hraardol.ll> Material (TIer II or RQ Flldltty) ANNUAL. <br /> <br />sparklers <br />Sprinkler System lnslallations <br /> <br />Standpipes (Sprinkler 5YI5) <br />Torch Roofing <br />Wast$ Tire Sttlrage ANNlJAL <br /> <br />I <br /> <br />Valuation of Project <br /> <br />'I <br />I <br />I <br />I <br />I <br />1 <br /> <br />Company <br />Registered ' <br />Ucsnse # 'I <br /> <br />Company E- <br />Registered Y I N- , <br /> <br />Weens. # I <br /> <br />Company ',I' <br />Registered [ Y / N J <br />Ucense ~ I <br /> <br />l Y/N I <br />I <br /> <br />Company I <br />Ftegistered , Y I N <br />L-ic;ense ~ 1 <br />11 IT <br /> <br />v -~ W~~~'~_ I <br /> <br />Y/N I <br />I <br /> <br />Fee Current I. Y I N I <br />I <br />': <br />Y IN I <br />I <br /> <br />Fee CUlTent ! Y I N I <br />~ <br /> <br />Y/N <br /> <br />Fee CulTent ' <br /> <br />- <br />FeQ Current <br /> <br />Company <br />Registellid <br /> <br />Ucense :# <br /> <br />Fee CUrJ1Int 1 Y I N I <br /> <br />v-~ <br /> <br />PAGE: 1 <br />