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<br />813-780-0020 <br /> <br />City of.Zephyrhi/ls Fire <br />Permit Application <br /> <br />if 1 ?f3tf <br />1 <br /> <br />Fax-813-780-0021 <br /> <br />Phone Contact for Permit <br /> <br /> <br />Date Received .- .- ~ -:J C1C)Y -- <br /> <br />Owner's Name 51-.4\. fY/edJ( G-/ <br /> <br />Owner's Address <br /> <br />{' ~y-ej--e, <br /> <br />II <br /> <br />Owner's Phone Number <br /> <br />I Titleholder Phone Number I <br /> <br />/I <br /> <br />II <br /> <br />Fee Simple Titleholder Name <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />67(9 <br /> <br />6ut1 B/vcL- <br /> <br />I Lot# <br /> <br />Sub Division <br /> <br />I <br /> <br />{Ul> I AINt:U t"KUIVlI"'KUI"'t:K J Y II'V. l'lU 11l-t:) <br /> <br />Parcel # <br /> <br />BID-Hazard Waste Storage - ANNUAL <br /> <br />---u <br />D <br />D <br />D <br />D <br />D <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />El FUllliYi:lliUII Ttlllt <br />D Hazardous Material (Tier II or RQ Facility) ANNUAL <br />o Hood Installation <br />D LP/Natural Gas-Installation <br />o LP/Natural Gas-ANNUAL Sale <br />o Places of Assembly-ANNUAL <br />c==J RecreationalBum <br />o Sparklers <br />D Sprinkler System Installations <br />D Standpipes (Sprinkler Sys) <br />D Torch Roofing <br />o Waste Tire Storage ANNUAL <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 - ~ <br />Sprinkler [!::f <br />Fire Alarm D <br />Hood Clean/Suppression D <br />Fire Alarm Installation <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Yy <br /> <br />Fuel Tanks <br /> <br />-I Valuation of Project <br /> <br /> <br />Contractor Company I <br />Signature Registered <br />Address I '-I7eJr CX&k... Pc-cr f!t.- -r~ Pi- ,,,,6 License # I <br />ELECTRICIAN I Company I <br />Signature I Registered <br />Address I I License # I <br />PLUMBER I Company I <br />Signatur€ Registered <br />Address I I License # I <br />MECHANIC4 I Company I <br />Signature - Registered <br />Address I I License # I <br />OTHER I Company I <br />Signature Registered <br />Address I I License # I <br />Directions: <br /> <br />Other: <br /> <br />~Sj rn-~ /.v b-t-1OrN! J( <br />Y IN Fee Current I Y I N <br /> <br />Y/N I Fee Current Y/N <br /> <br />Y I N I Fee Current I Y I N I <br />I <br /> <br />Y I N I Fee Current I Y I N I <br />I <br /> <br />Y I N I Fee Current I Y I N I <br />l <br /> <br />Fill out application completely. <br />ownef&ColitractoFsignDaCk-of applicati6n,ootariZea{Ot;copy-Ofsignea con1FclctWitl1 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 />