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<br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />813-780-0020 <br /> <br />City of ZJphyrhills Fire <br />Permit lA.pplication <br /> <br />~1d7f <br />~ 1 <br /> <br /> <br />Fee Simple Titleholder Name <br /> <br />Fax-813-780-0021 <br /> <br />Phone Contact for Penn it <br /> <br /> <br />S:-/~ <br />~ 3S' ~ <br /> <br />Titleholder Phone Number <br /> <br />117;)... I J ~9J7 <br /> <br />II <br /> <br />II <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />I Lot# <br /> <br />Sub Division <br /> <br />6'70) /)e,/vy ~J <br /> <br />Parcel # <br /> <br />(Uti I AINt:U I-KUM t-'KUt-'t:K I Y I AX NU 11l;t:) <br /> <br />Contractor <br />Signature <br />Address I <br />ELECTRICIANI <br />Signature . <br />Address I <br />PLUMBER <br />Signature <br />Address I <br />MECHANICALI <br />Signature . <br />Address I <br />OTHER <br />Signature <br />Address <br /> <br />D <br />D <br />D <br />D <br />D <br />[ZI <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br />Comm Exhaust Kitchen Hood/Duct <br />Controlled Bum <br /> <br />D <br />10 <br />'0 <br />10 <br />10 <br />o <br />o <br />o <br />o <br />'D <br />io <br />'0 <br /> <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />Sprinkler 0' 6? <br />Fire Alann D <br />Hood Clean/Suppression D <br />Fire Alann Installation <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />Fumigation Tent <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 />Recreational Bum <br /> <br />Sparklers <br />Sprinkler System Installations <br />Standpipes (Sprinkler Sys) <br />Torch Roofing <br />Waste Tire Storage ANNUAL <br /> <br />Valuation of Project <br /> <br />Other: <br /> <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <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 /> <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 Fee Current <br /> <br />Y/N <br /> <br />Y I N I Fee Current <br /> <br />Y IN I <br /> <br />Directions: <br /> <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 />