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<br />813-780-0020 <br /> <br />Date Received <br /> <br /> <br />City of 2ephyrhills Fire <br />Permit Application <br /> <br />Phone Contact for Permit <br /> <br />Fax-813-78D-0021 "11\0 <br /> <br />ner's Name <br /> <br />I (3~ 13~ <br />I <br /> <br /> <br />~?~ <br /> <br />II <br /> <br />II <br /> <br />Owner's Phone Number <br /> <br />Owner's Address <br /> <br />Fee Simple Titleholder Name <br />Fee Simple TItleholder Address <br /> <br />I <br />I <br /> <br />I Titleholder Phone Number I <br /> <br />II <br /> <br />II <br /> <br />Job Address <br /> <br />;? ~ Iy' c:f( ~ aU 13,W <br /> <br />Sub Division <br /> <br />Parcel # <br /> <br />D Bio-Hazard Waste Storage - ANNUAL <br />D Comm Exhaust Kitchen HoodlDuct <br />D Controlled Bum <br />0 . Emergency Generator < 30 kw <br />D Emergency Generator> 30 kw <br />D Fire Protection Maintenance - ANNUAL <br /> Sprinkler ~ <br /> Fire Alarm <br /> Hood Clean/Suppression D <br />D Fire Alarm Installation <br />0 Fire Pumps <br />0 Fire Works <br />0 Flammable Application- ANNUAL <br />0 Fuel Tanks <br />0 Other: <br /> <br />I Lot# <br /> <br />I <br /> <br />lUl) I AII~t:U t"t'(UIVI t"t'(Ut"t:t'( 11 I f\A I~U 11~t:) <br />-..- <br /> <br />D Fumigation Tent <br />D Hazardous Material (Tier II or RQ Facility) ANNUAL <br />D Hood Installation <br />D LP/Natural Gas-Installation <br />D LP/Natural Gas-ANNUAL Sale <br />D Places of Assembly-ANNUAL <br />D ReareationalBum <br />D Sparklers <br />D Sprinkler System Installations <br />D Standpipes (Sprinkler Sys) <br />D Torch Roofing <br />D Waste Tire Storage ANNUAL <br /> <br />, f Valuation of Project <br /> <br />Contractor <br />Signature <br /> <br />Address I <br /> <br />ELECTRICIAN <br />Signature I <br /> <br />Address I <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />OTHER <br /> <br />Signature <br /> <br />Address <br /> <br />Directions: <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y/N I Fee Current Y/N <br /> <br />Y/N' Fee Current I Y/N <br /> <br />Y/ N I Fee Current <br /> <br />Y/N <br /> <br />Y I N I' Fee Current <br /> <br />Y/N <br /> <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 \/\IOrk over $5000) <br />Supply two (2) sets of drawings with applicable documentation <br />Allow 10-14 days for review after submittal date. <br />