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<br />City of.Zephyrhilis Fire <br />Permit Ap~lic2tiotl <br /> <br />pate R.eceived. l . ,-\"'" .~. _' , , Ph?~e_CO!1taGt fo;:permit T <br />,,,,~~~"l",,~,,,,,,,,,=,,.~,t,_..,~,........~,,,~~m:~~~';"~ <br /> <br />Owner's NamE C5?~~~c.~ l Owner's Phone Number [: 6\~ <br /> <br />Owners Address L-,-~~-,9~\ '~6...A.''\~ ~ \ Z ..u>~,^'~~~ 'r-L <br />'3Cft Z<f(5 g jfj4(L l I II' I ' <br />Fee Simple TII'ehoIdAII"m' 'I i 1111"mld" pnone Numbel . I <br /> <br />F=ee Simple Titleholder Address [: ~ ~ ; <br />""""~"",,,,.~~';' <br /> <br />r j Lot# I <br />t. l~ ~ <br />__ Palcei'# _ <br />\UIJ I i\.INt:.LJ rKUM l"'KUj-'t:KI ~ Ii',,"- NU II\...C) <br />_ ."",.~~~~~~~~~"!j&;R'~ <br /> <br />i <br /> <br />I <br />\ <br /> <br />I <br /> <br />l 8omc.any I <br />Registered Y i N <br />I '; <br /> <br />J Ucoose'iT! <br />..._,~ ..:;;.~ ~~,-,,"'!i~~~-. """"J__..I""~~.:":rJ~~' ,..."".... ~~'"*"""'=...... <br /> <br />. 813-7~q-0020 . <br /> <br />job Address <br /> <br />Sub Division <br /> <br />"'n::~.~,~..,-j:~~~~~~ <br />o Bio-Hazard Waste Stcrage - ANNUAL <br />D Camm Exhaust K1tdltm HoodlDuct <br />D Controlled Bum <br />01, <br />Emergency Generator <:; 30 "..... <br />[] Emergency Generator;;. 30 \\\V <br />~ Fire Protection Maintenance - ANNUAL <br /> <br />D <br />CJ <br />o <br />!j <br />L--. <br />o <br />o <br />o <br />o <br />o <br />LI <br />o <br /> <br />Sprinkler <br /> <br />o <br />o <br />1:81. <br /> <br />Fire .4larm <br /> <br />Hood CleanfSuppression <br /> <br />1 I <br />o <br />D <br />o <br /> <br />c==J Fuel Tanks <br />c==J ()ther; r <br /> <br />=f~ .,-~- \ <br /> <br />~ .Address L..._ ~C u ~\ ~~IA.:Ie....~ ?'"'J~~ <br />ElECTRICI.l1N, I <br />Signature I I <br /> <br />Address t_ .j <br /> <br />PLUMBER i\ <br />SIPI18tlJr8 . . <br /> <br />.4ddress 1 <br />, : <br />MECHANICAL\ <br />SIgna lure - , <br /> <br />Address I <br /> <br />OTHER I <br />SignalJ.lre \ <br /> <br />~=J:~" <br />O:n;:c:;ons: "'--_.,-r",;;:;"""-..:-,.... .~--~"?'""-~..~-~~~' <br /> <br />Fire i'\iarrn installation <br /> <br />Fire pumps <br /> <br />FIre Works <br /> <br />Flammable Applicanon- ANNUAL <br /> <br />if '111 e, <br /> <br />fax-813-780-m21 <br /> <br />.JJ . .=...ll~,..~ <br />II -\6'f> J r \ 1.r1.:S <br /> <br />~ <br /> <br />Fum,~rafk:;~ Tent <br /> <br />Hazardcus Material (Tier II or RQ Facility) ANNUAL <br /> <br />Hood Installation <br /> <br />LP.lNa'iur;:;! Ga~-:nstaHgjjon <br /> <br />LPfNatural Gas-ANNUAL Sale <br /> <br />Places of Assembly-ANNUAL <br /> <br />R:e.:r€ah~na\ Bl:m <br /> <br />Sparkiers <br /> <br />Sprinkler System lnstaUations <br /> <br />Stancfp~p~ (Sprink:er Sys) <br /> <br />lorch Rcoftng <br /> <br />n Waste Tire Storage ANNUAL <br />"---' <br /> <br />I Valuation of Project <br /> <br /> <br /> <br />"'_~~ '_~__,"""''''.. ,~,-, -"''''.,..'.....;!''"''''''''''"'''"'':!!.'If: <br />I <br />Ccmpany \ <br />Registered ! Y J N <br /> <br />Fee Current <br /> <br />Y I N I <br />J <br /> <br />I <br />Company I <br />Registered I <br />r <br /> <br />Ucense #- <br /> <br />Y1N <br /> <br />Fee Current <br /> <br />Y!N <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />r Y/N <br />I <br />~ <br /> <br />Fee Current <br /> <br />Y IN I <br />] <br /> <br />Fee Current <br /> <br />Y iN \ <br />~l <br /> <br />Ucense # <br /> <br />Company <br />Registered <br /> <br />,(/ N <br /> <br />UCBI1Se "# <br /> <br />Y iNI <br />\ <br />.. --.,,~~~~-~,- '" -~=~~ <br /> <br />ree Current <br /> <br />Fin out application completely. <br />C;\'VI1sr & 9ontractor, sign back of ap;:lication,notartzed (O~, copy of sig"1OO contra::t 'Nit": owner) <br />" over $2:-,00, a Notice of Commencement is required (Mechanical 'NOk -, .€" :);5000: <br />Supply tvvo (:2) sets of drawings with applicable documentation ' <br />,",!!GW 1 0-14 days for review after submittal date, <br />