Laserfiche WebLink
<br />City of ZJphyrhills Fire <br />Permit lA.pplication <br /> <br />Date Received..., J \ - or -o~ ,I Phone, Contact for Permit <br /> <br />/ ::::-~~.. DLl:;:~ 'U=::,,:.,m: <br />I::*~~~~~ <br />4""4 (,.,U.l::h)a _ ~8 <br />I <br />I <br /> <br />/ Owner's Address <br /> <br />813-780-0020 <br /> <br />Fax-813-780-0021 <br /> <br />l_,_-LL,!\",,,,,,,_,,lL'o~'>"W.'=!!li_1 <br />I II I J I <br />I <br />I <br />I <br /> <br />i <br />Arl't+.rtlCA. ~ a,'ol....7~n0 <br /> <br />i I Titleholder Phone Number I <br /> <br />Fee Simple Titleholder Name <br /> <br />Fee Simple Titleholder Address <br /> <br />II <br /> <br />II <br /> <br />,/ Job Address <br /> <br />Sub Division <br /> <br />I Lot# <br /> <br />54'2-0 <br /> <br />~a...Q....9- &. QeD <br /> <br />Parcel # <br /> <br />(Uts I AINl::U I-KUM t-'KUt-'l::K I Y I AX NU 11t;l::) <br /> <br />Fumigation Tent <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 />Bio-Hazard Waste Storage - ANNUAL <br /> <br />o <br />o <br />o <br />o <br />o <br />8 <br />o <br />o <br />ds <br />10 <br />I <br />I <br />I <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 /> <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 />Fuel Tanks <br /> <br />~(~ <br />Y I N Fee Current <br /> <br />Y/N <br /> <br />i_l_lll' <br />Contractor Company <br />Signature Registered <br />Address License # <br />ELECTRICIANI I I Company <br />Signature i Registered <br />Address I i I License # <br />PLUMBER I Company <br />Signature Registered <br />Address I i I License # <br />MECHANICALI I Company <br />Signature Registered <br />Address I I License # <br />OTHER I Company <br />Signature Registered <br />Address License # <br />Directions: <br /> <br />Comm Exhaust Kitchen Hood/Duct <br />Controlled Bum <br /> <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />Sprinkler D <br />Fire Alarm D <br />Hood Clean/Suppression D <br />Fire Alarm Installation <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Y/N <br /> <br />Y I N Fee Current <br /> <br />Y I N I Fee Current <br /> <br />Y/N <br /> <br />, Y I N I Fee Current <br /> <br />Y/N <br /> <br />Y I N I Fee Current <br /> <br />Y/N <br /> <br />Fill out application completely. I <br />Owner & Contractor sign back of application, notarized (Or. COPIt 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 i <br />Allow 10-14 days for review after submittal date. ' <br /> <br />I <br />