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<br />City of ZJphyrhills Fire <br />Permit lA.pplication <br />! <br />I <br /> <br />813:780-0020 <br /> <br />Date Received <br /> <br /> <br />#' 1lfD7 <br /> <br />Fax-813-780-0021 <br /> <br />Phone Contact for Permit <br /> <br /> <br />IL 7'152[:0 -I-/ORV?t7H <br />\2 3 0 4 'POTO J1A C MfJ4( k qr>1.. <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />I Owner's Phone Number I II II <br /> ~('(SKI N FL 33S-7c1 <br />I Titleholder Phone Number I II II <br /> <br />Fee Simple Titleholder Name <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />cHlftJ.r1 <br /> <br />wo~ <br /> <br />11. ~'f <br /> <br />I Lot# <br /> <br />Gtf L L <br /> <br /> <br />I I Parcel # <br /> <br /> <br />I 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 Recreational Bum <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 />Sub Division <br /> <br />D Bio-Hazard Waste Storage - ANNUAL <br />D Comm Exhaust Kitchen HoodlDuct <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 0' <br /> <br />D Fire Alarm Installation <br />D Fire Pumps <br />D Fire Works <br />D Flammable Application- ANNUAL <br />D Fuel Tanks <br />D Other: <br /> <br />I~~ <br /> <br />ZLVD <br /> <br />(Utll AINt::U I-KUM I-'KUI-'t::K I Y I AX NU 11l;t::) <br /> <br />Valuation of Project <br /> <br />Contractor <br />Signature <br />Addres~; I <br />E~ECTRICIANI <br />Signature <br />Address I <br /> <br />b <br /> <br />'\ <br /> <br />PLUMBER <br />Signature <br />Address I <br />MECHANICALI <br />Signature <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />I <br /> <br />Address <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br /> <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />lIJ.//~S 5-5f(V/~cS <br />Y / N I Fee Current I Y / N I <br /> <br />I <br /> <br /> <br />Y / N I Fee Current Y / N I <br /> <br />I <br /> <br /> <br />Y I N I Fee Current Y / N I <br /> <br />I <br /> <br /> <br />. Y / N I Fee Current Y / N I <br /> <br />I <br /> <br /> <br />Y / N I Fee Current Y / N I <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 (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 />