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<br />'1=O'R C 3 i 2 f ! 0 ~. I' <br />813-780-0020 r- L J City of Z~phyrhills Fire 1:f 1 ~~3 Fax-813-780-0021 <br />," ;; P~rmit ~pplication_ . <br />;~;~~~:~~_%WJk_mL2;il2"~;l:l,\,,L~;~r~lfM_;fMlIldl$lii!"!1mmmmr!B-JmIm-=~=~L_"'~m@,wJl_~~",~,.tl___1 <br />I LA-$2La fk) R 1/ AT H i I Owner's Phone Number I g I ~ 1151-51 J 1 J5A <br />I -:r 0 "80 X G/73g TITMPA =F-L :33 b 74 I <br />I I Titleholder Phone Number I II II I <br /> <br />Fee Simple Titleholder Address I I <br /> <br />\WJ!Rlfflllm'~1&k~~a1li__~~__~~I~~" l~~U ~'t~__ <br /> <br />I LITTL~ Ctr:t.5:A-RS 'SLVi) I Lot# <br />I <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />Fee Simple Titleholder Name <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />SS-38 (;.A-LL <br /> <br /> <br />I Parcel # " <br /> <br />(Uti 1 AINI:;U I-KUM t-'KUt-'I:;K 1 Y 1 AX NU J 1\.;1:;) <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br /> <br />D Fumigation Tent <br />o Hazardous Material (Tier 1/ or RQ Facility) ANNUAL <br />D Hood Installation <br />',0 <br />LP/Natural Gas-Installation <br />D LP/Natural Gas-ANNUAL Sale <br />D Places of Assembly-ANNUAL <br />D Recreational Bum <br />D Sparklers <br />D Sprinkler System Installations <br />D Standpipes (Sprinkler Sys) <br />o Torch Roofing <br />D Waste Tire Storage ANNUAL <br /> <br />c.ontractor! /7 #'7 ~~ <br />SIgnature . ~ ~ <br /> <br />Address <br /> <br />ELECTRICIANI <br />Signature , <br /> <br />Address I <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br />Signature , <br /> <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />D <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 />Comm Exhaust Kitchen Hood/Duct <br /> <br />Controlled Bum <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />Sprinkler D <br />Fire Alarm D <br />Hood Clean/Suppression D <br />Fire Alarm Installation <br /> <br />Fire Pumps <br />Fire Works <br /> <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />I <br />EXl4AII~r <br /> <br />I Valuation of Project <br />CL~A-)JJM6 <br /> <br />t.(N/~ERSE e..EF<V/CE<.> <br />Y I N I Fee Current I Y I N I <br />I <br /> <br />Y I N I Fee Current Y I N I <br />I <br /> <br />Y I N I Fee Current Y I N I <br />I <br /> <br />Y I N I Fee Current Y I N I <br />I <br /> <br />Y I N I Fee Current Y I N I <br /> <br />Other: <br /> <br />I CO/w1PLT:-'T13 <br /> <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 />Registered <br /> <br />Address License # <br /> <br />Directions: I <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 />