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<br />City of Zephyrhills Fire <br />Permit Application <br /> <br />Date Rece:ived <br /> <br />I Titleholder Phone Nbr <br /> <br />II II <br /> <br />I <br />I <br />I <br />I <br />I <br /> <br />1~200R <br /> <br />Contact Phone Nbr <br /> <br />352-424-0906 <br /> <br />Owner Name <br /> <br />Owner Phone <br /> <br />I Dairy Queen <br />Owner Address . <br /> <br />Fee Simple Title Holder I <br />37930 Medical Arts Court <br /> <br />R13 <br /> <br />I I 7RO I I 2R26 <br /> <br />Fee Simpl<e Titleholder Address <br /> <br />Job Address <br /> <br />I S.... G.. Bh" _., Fl <br /> <br />Lot Nbr. <br /> <br />.37130 1Yla> 1"-fJ:L Af<T, <br />I Parcel ID <br /> <br />L-TI <br /> <br />Subdivision <br /> <br />B Bio-Hazard Waste Storage - ANNUAL D <br /> Fumigation Tent <br /> Comm Exhaust Kitchen Hood - Duct D <br />D Hazardous Material (Tier II or RQ Facility) Annual <br />Controlled Burn D <br /> Hood Installation <br />D EnII~rgency Generator <30 KW LP - Natural Gas Installation <br />D Emergency Generator> 30KW D <br />D Fire Protection Maintenance - Annual D LP - Natural Gas Annual Sale <br /> Sprinkler D D Places of Assembly - Annual <br /> Fire Alarm D <br /> Hood Clean - Suppression ~ B Recreational Bum <br />D Fire alarm Installation Sparlders <br />D Flire Pums B Sprinkler System Installations Value of Project <br />D Filre Works Standpipes ( Sprinkler System) $ I I <br />D Flammable Application - Annual B Torch Roofmg <br />D Fuel Tanks Waste Tire Storage Annual <br />D Other: I <br /> <br />Company <br /> <br />Contractor Sign <br /> <br />Address <br /> <br />Registered <br /> <br />y <br /> <br />N I Fee Current I <br /> <br />Electrician Sign. <br /> <br />License <br />Company <br /> <br />Address <br /> <br />Registered <br /> <br />y <br /> <br />N I Fee Current I <br /> <br />Plumber Sign <br /> <br />License <br /> <br />Address <br /> <br />Company <br /> <br />Mechanical <br /> <br />Registered <br /> <br />y <br /> <br />N I Fee Current I <br /> <br />Address <br /> <br />License <br /> <br />Other Sign <br /> <br />118330 Lawrence Rd. Dade City, Fl <br /> <br />Company <br /> <br />Address <br /> <br />Registered <br /> <br />y <br /> <br />N I Fee Current I <br /> <br />I <br /> <br />Directions: <br />Fill out application completely. Company <br />Owner & Contractor sign back of application, notorize ( Or signed <br />Copy of contract with owner) Registered <br />If over $2500.00, a Notice of Commencement is required <br />Mechanical work of ( $5000.00 ) requires a Notice of Commencent <br />Supply two (2) sets of drawings with applicable documentation <br />Allow 10 - 14 days for review after submittal date. <br /> <br />License <br /> <br />Security Fire Equipment, LLC <br />Y N I Fee Current <br />502552000220004 <br />