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<br />Date Received <br /> <br />~/Owner's Name! <br /> <br />Owner's Address <br /> <br />813.,780-002Q. <br /> <br />City of zJphyrhills Fire <br />Permit \A.pplication <br />! <br />I <br /> <br /> <br />l;3 <br /> <br />:;;~~~/ ~d5 <br />I <br />I <br />~~ ( j () <br /> <br />Fee Simple Titleholder Name <br /> <br />Fax-813-780-0021 <br /> <br /> <br />Phone Contact for Permit <br /> <br />II <br /> <br />I J <br /> <br />! I Owner's Phone Number I <br /> <br />2t ~J..v/j/(!r I F! <br />:'8, . <br />I Titleholder Phone Number I <br /> <br />II <br /> <br />II <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />reAlf <br /> <br />Parcel # <br /> <br />I Lot# <br /> <br />(uts I AINt:U I-KUM t-'KUt-'t:K I Y I AX NU 11l,;t:) <br /> <br />Jl Contractor <br />- '-signature <br /> <br />Address I <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 />Addres:s <br /> <br />D <br />D <br />D <br />D <br />D <br />0' <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />Comm Exhaust Kitchen Hood/Duct <br /> <br />Controlled Bum <br /> <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br /> <br />Sprinkler <br />Fire Alarm <br />Hood Clean/s~n <br />Fire Alarm Installation <br />Fire Pumps <br /> <br />D <br />~ <br /> <br />Fumigation Tent <br />Hazardous Material (Tier II or RQ Facility) ANNUAL <br />Hood Installation <br /> <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 />~pany <br />~gistered <br /> <br />License # <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 />Valuation of Project <br /> <br />Other: <br /> <br />1~~(~3ei~~ - <br />I <br />Y I N I <br />I <br /> <br />I~ <br />I <br /> <br />I Y IN I <br />I <br /> <br />I Y IN I <br />I <br /> <br />I Y/N I <br />I <br /> <br />I Y/N <br /> <br />Fire Works <br /> <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Fee Current <br /> <br />Y/N <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 I <br />Allow 10-14 days for review after submittal date. <br />