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<br />81:1-78{}..Q020 <br /> <br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />Phone Contact for Permit <br /> <br /> <br />City of.Zephyrhllls Fire <br />Permit Application <br /> <br />Fax-813-780-0021 <br /> <br />f~!!^.,.t<I - ,(,.... f., <br />_ ~~\D ~ Bo.\\ <br /> <br />??:>s "\, <br /> <br />Fee Simple Titleholder Name <br /> <br />1 Owner's Phone Number <br /> <br />ca.,) II ~~2-11 <t.,SD <br /> <br />II <br /> <br />II <br /> <br />I TItleholder Phone Number r <br /> <br />A.t:l_ -_,,1WiJIl <br /> <br />,~ vr-- <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub DIvision <br /> <br />~..".,,_ ..---IM JU <br /> <br />D <br />D <br />D <br />D <br />D <br />~ <br /> <br />D <br />o <br />o <br />o <br />D <br />D <br /> <br />Contractor <br />Signature <br />Address <br /> <br />ELECTRiCIAN <br />Signature <br /> <br />Address I <br /> <br />I <br /> <br />PLUMBER <br /> <br />Signature <br /> <br />Address I <br /> <br />MECHAN'C.4. <br />. Signature <br /> <br />Addr~;s I <br /> <br />OTHER <br />Signature <br /> <br />[ <br />L <br /> <br />J Lot# <br /> <br />~ <br /> <br />Bia-Hazard Waste Storage - ANNUAL <br />Comm Exhaust Kitchen HoodlDuct <br />Controlled Bum <br />. Emergency Generator < 30 kW <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />Spnn~er r==J <br />Fire Alann D <br />Hood CleanJSuppresslon ~ <br />Fire Alarm Installation <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br />Other: r <br /> <br />Parcel # <br /> <br />lUljIAINl:.U rKUM t"KUt't:KI Y IAA NUllv:L <br /> <br />-" <br /> <br />D Fumigation Tent <br />o 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 />D Places of Assembly-ANNUAL <br />D Recreational Bum <br />o Sparklers <br />o Sprinkler System Installations <br />o Standpipes (Sprinkler Sys) <br />o Torch Roofing <br />o Waste Tlfe Stocage ANNUAL <br /> <br /> <br />I ., Valuation of Project <br /> <br /> <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br /> <br />_ ~__ c -] <br /> <br />Company I <br />Registered <br /> <br />l <br />I <br />r <br />I <br />I <br />f <br />I <br />I <br /> <br />Y/N I <br /> <br />Fee Current I <br /> <br />Y IN I <br />I <br /> <br />I <br />I <br /> <br />I <br />I <br /> <br />I <br />I <br /> <br />! <br />I <br /> <br />~ . ~ddre~~J~..~.....'.~___ ~ ._~~_ _~~"'~~ ~ <br /> <br />Directions: <br />Fill out application completely. <br />Owner & Contractor, sign back of application,notartzed (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 appllcable doc:umentallon <br />Allow '\ 0-14 clays for review after submittal date. <br /> <br />Ucense # <br /> <br />Company <br />Registered <br /> <br />Fee Current I <br /> <br />Y/N I <br /> <br />Y/N <br /> <br />LIcense # <br /> <br />Company <br />Registered <br /> <br />Fee Current I <br /> <br />Y/N I <br /> <br />Y/N <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />Y / N I Fee Current <br /> <br />Y/N <br /> <br />Ucsnse # <br /> <br />Company <br />Registered <br /> <br />License 11 l <br />.... ___..~oI""".. ~___.",~'_-i~L.-.~Ir:"_ <br /> <br />Fee Current I <br /> <br />Y/N I <br /> <br />Y/N <br />