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<br />City of ZephyrhiUs Fire <br />Permit Application <br /> <br />f~:;&&=~~~~w___L~~-'>..J~,"zm_L__m_%_,m.Ph?~\;B~~~:,~I.~~__~ <br />1~~~&:vrI) I owner'sPhoneNumberlqJ3 111Q~ 11q;ld~ I <br />1Mj:y) Go./f (YJu Ie co.rd ~~rhl 11 <s/ ~<.. ?-OS4 ( I <br /> <br /> <br />I I Titleholder Phone Number I ---t1 r I <br /> <br />I --- I <br /> <br />8'13-780-0020 <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />Fee Simple Titleholder Name <br /> <br />Fee Simple Titleholder Address <br /> <br />7S'ft <br /> <br />Fax-813-780-0021 <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />~UI'le <br /> <br />I Lot# <br /> <br />Parcel # <br /> <br />tUtll AINt:U l-KUM ~KU~t:K I Y I AX NU IIL;t:) <br /> <br />D <br />D <br />D <br />D <br />D <br />.El <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />Bic-Hazard Waste Storage - ANNUAL <br />Comm Exhaust Kitchen Hood/Duct <br />Controlled Bum <br /> <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />Sprinkler D <br />Fire Alarm ~ <br />Hood Clean/Suppressio; 0 <br />Fire Alarm Installation <br /> <br />Fire Pumps <br />Fire Works <br /> <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />D <br />o <br />o <br />D <br />D <br />o <br />o <br />o <br />o <br />D <br />D <br />o <br /> <br />Fumigation Tent <br />Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> <br />Hood Installation <br /> <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 />UgoQti) <br /> <br />Other: <br /> <br />Valuation of Project <br /> <br />Company I <br />Registered Y I N I Fee Current <br /> <br />License # I <br /> <br />Company I <br />Registered Y IN' Fee Current <br /> <br />License # I <br /> <br />Company I <br />Registered Y I N I Fee Current <br /> <br />License # I <br /> <br />Company I <br />Registered . Y I N I Fee Current <br /> <br />License # I I <br /> <br />~i:;~re I~JI fJ~. I ~:;:t:~~d 1~~lili~~~'~I\(' I <br />~J<mJ~li!!L-B~,iL'*6~~_'_'~"~'!::~l!Qi~__~~_w_,~l---&$_ <br /> <br />Fill out application completely. <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 <br />Allow 10-14 days for review after submittal date. <br /> <br />Contractor <br />Signature <br /> <br />Address I <br /> <br />ELECTRICIANj <br />Signature <br /> <br />Address I <br /> <br />PLUMBER <br /> <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br />Signature <br /> <br />Address I <br /> <br />'~ 't <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Y/N <br />