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<br />Date Recei'Ved <br /> <br />H - d-.c; <br /> <br />Owner Name <br /> <br />City of Zephyrhills Fire <br />Permit Application <br /> <br />I <br />I <br /> <br />Dominos Pizza <br /> <br />Contact Phone Nbr <br /> <br />Owner Address <br /> <br />5050 Gall Blvd. <br /> <br />Owner Phone <br /> <br />II 7900 <br /> <br />I R13 <br /> <br />II 779 <br /> <br />I Titleholder Phone Nbr <br /> <br />II <br /> <br />Fee Simple Title Holder <br /> <br />II <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />I 5050 Ow, Blvd <br /> <br />Subdivision <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br />Comm Exhaust Kitchen Hood - Duct <br /> <br />o <br />o <br />o <br />~ <br /> <br />ControlIed Bum <br /> <br />Eml.'Tgency Generator <30 KW <br /> <br /> <br />Emergency Generator> 30KW <br /> <br /> <br />Fire Protection Maintenance - Annual <br /> <br />(l?('Y'c>>('\ -\- <br /> <br />Lot Nbr. <br /> <br />o <br />~ <br /> <br />o <br />o <br />o <br />o <br />o <br />o <br /> <br />Sprinkler <br />Fire Alarm <br />Hood Clean - Suppression <br />Fire alarm Installation <br />Fire Pums <br />Fire Works <br />Flammable Application - Annual <br />Fuel Tanks <br /> <br />Parcel ID <br /> <br />o <br />o <br />o <br />o <br />o <br />o <br /> <br />Fumigation Tent <br />Hazardous Material (Tier II or RQ Facility) Annual <br />Hood Installation <br /> <br />LP un Natural Gas Installation <br /> <br />LP un Natural Gas Annual Sale <br /> <br />Places of Assembly - Annual <br /> <br />B <br />B <br />B <br /> <br />Recreational Bum <br /> <br />Sparklers <br />Sprinkler System Installations <br />Standpipes ( Sprinkler System ) <br />Torch Roofing <br />Waste Tire Storage Annual <br /> <br />Value of Project <br /> <br />$1 I <br /> <br />Other: I <br /> <br />Contractor Sign I Company <br />Address I Registered <br />Electrician Sign. License <br /> Company <br />Address I <br /> Registered <br />Plumber Sign License <br />Address I Company <br />Mechanical I Registered <br />Address I/~ License <br />Other Sign L5~ Company <br />Address I 18330 Lawrence Rd. Dade City, FI Registered <br /> <br />Y N I Fee Current I <br /> <br />Y N I Fee Current I <br /> <br />Y N I Fee Current I <br /> <br />1 <br /> <br />Y <br /> <br />N I Fee Current I <br /> <br />License <br /> <br />Directionl,: <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 />Security Fire Equipment, LLC <br /><E> N I Fee Current 1./ ~ .s <br /> <br />502552000220004 <br />