Laserfiche WebLink
<br />I <br />City of Z~phyrhills Fire <br />Permit IApplication <br />I <br />I Phone Contact for Permit <br /> <br />:::: /0/ c~t I" Own", POOdnme, <br />"iii /Iv ~ I ~ ~t2H.JLL.J; <br /> <br />I I Titleholder Phone Number <br />1 <br /> <br />~ 813-780-0020 <br /> <br />Date Received <br /> <br /> <br />Owner's Name <br /> <br />~;: <br />I <br />I~;:-~~~?H <br />I <br /> <br />/lJlt- <br /> <br />Owner's Address <br /> <br />Fee Simple Titleholder Name <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />Fax-813-780-0021 <br /> <br /> <br />II <br /> <br />II <br /> <br />II <br /> <br />II <br /> <br />I Lot# <br /> <br />Parcel # <br /> <br />(Uti I AIN~U t-KUM I-'KUI-'~K I Y I AX NU "~~L=, <br /> <br />Fumigation Tent <br /> <br />D Bio-Hazard Waste Storage - ANNUAL <br />D Comm Exhaust Kitchen Hood/Duct <br />D Controlled Bum <br />D Emergency Generator < 30 kw <br />D Emergency Generator> 30 kw <br />~ Fire Protection Maintenance - ANNUAL <br />Sprinkler D <br />Fire Alarm D <br />Hood Clean/Suppression ~ <br />D Fire Alarm Installation <br />D Fire Pumps <br />D Fire Works <br />D Flammable Application- ANNUAL <br /> <br />D Fuel Tanks <br />D Other: <br /> <br />10 <br />10 <br />10 <br />o <br />D <br />D <br />o <br />D <br />D <br />o <br />o <br />o <br /> <br />Hazardous Material (Tier II or RQ Facility) ANNUAL <br />Hood Installation <br />LP/Natural Gas-Installation <br />LP/Natural Gas-ANNUAL Sale <br />Places of Assembly-ANNUAL <br />Recreational Bum <br /> <br />Sparklers <br />Sprinkler System Installations <br />Standpipes (Sprinkler Sys) <br />Torch Roofing <br />Waste Tire Storage ANNUAL <br /> <br />Valuation of Project <br /> <br />Contractor I L:1 <br />Signature ~ c:: ,D.~ <br /> <br />Address r; '33 0 c1~ 'ZtJ <br /> <br />ELECTRICIANI <br />Signature <br /> <br />Address I <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br />Signature <br /> <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />Address <br /> <br />! <br />I <br />I I <br />I I <br />I <br />I <br />I <br />I <br /> <br />va04 e~ <br /> <br />Company <br />Registered <br /> <br />I ( ~ <br />,...~ r;;l. J '7?QC r(;D/ , <br />. (yfN f 4ecurrent I Y I NI <br /> <br />i S=~"l?DOV/~O'~~ : <br />· Y I N I Foo C'_- Y IN. <br />I <br /> <br />License # <br /> <br />Company <br /> <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />Y I N I Fee Current <br /> <br />Y/N <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />,Y I N I Fee Current <br /> <br />Y/N <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />Y/N <br /> <br />Y I N Fee Current <br /> <br />License # <br /> <br />Directions: <br /> <br />Fill out application completely. I <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 (Mechani~1 work over $5000) <br />Supply two (2) sets of drawings with applicable documentation . <br />Allow 10-14 days for review after submittal date. <br />