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<br />City orZephyrhills Fire #~8{ ( Fax-813-780-0021 <br />Permit AP~licati~ ~J~ . c', _ <br />t Ph.O~tact~orpermit J"?)J,~ L1~1 l_fsCAW <br />~~:m!:~~"";.;:"~-.,;.;;..,,,~,~.~~,~~4~.~~~~~:;;;;''':';;~''''-'''''~''''4iO;-:i <br /> <br />!1::n II ~I 117300 <br /> <br /> <br />813-780-0020 <br /> <br />Date Received <br /> <br />Owner's Name <br /> <br />owne, r'SAddres1 'lY~ GtoJ J Blud <br />3'3/0 l#J~~ /M-sr1dO <br />Fee Simple Titleholder Na, m~) <br />Af.lduii1{.(. ,/" )11-':- <br />Fee Simple TItlenofder Address <br /> <br />::::-~--~-~ <br /> <br />Sub Division <br /> <br />Titleholder Phone Number I <br /> <br />II <br /> <br />II <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br /> <br />v~[ :,llIlflw'W~l~LJl[lllln n- Ai~~i~q~~~ <br /> <br />I Lot# I <br />Parcel # 9u~ ~N~~?i -;K~~~ ~r~ E ~~~~~ CtJZc <br /> <br />D <br />D <br />D <br />D <br />D <br />181 <br /> <br />o <br />D <br />o <br />o <br />D <br />D <br />D <br />o <br />o <br />D <br />D <br />D <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 - ANNUAL <br /> <br />Sprinkler <br />Fire Alarm <br /> <br />D <br />5?J <br />D <br /> <br />Hood Clean/Suppression <br /> <br />D Fire Alarm Installation <br />D Fire Pumps <br />D Fire Works <br />D Flammable Application- ANNUAL <br />D Fuel Tanks <br />D Other: I <br />~~IW"'~~=<l~~~~"...,...~'ft:iii:ltl <br />~~ <br /> <br />Fumigation Tent <br />Hazardous Material (Tier II or RQ Facility) ANNUAL <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 />Valuation of Project <br /> <br />~m <br /> <br />~HI[II11lrTI~~~~~~~~~~ <br /> <br />Signature <br /> <br /> <br />_..~;;~~,,~,~,~ """,'"'>""',"."""c.';',',~,_',_.'~"._,"'==',.,,;""",,_,-;;;m"~~<',"'-,o,~__'"".,,~'" <br />Directions: <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 />Add""" : 3"1'1 1'1 <br /> <br />ELECTRICIAN <br />Signature <br /> <br />Address I <br /> <br />NeQ~ "?\ <br /> <br />\xd( Ct~ I ~L :?;;?,:>c.:J.) ~-, <br /> <br />PLUMBER <br /> <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br />Signature , <br /> <br />Address I <br /> <br />OTHER <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 />l~o..lf''/t ~/-eWOJJI CS~ <br />.~N r Fee Current 1_ N I <br />I EF-.. 00010'-/1,.-1) I <br /> <br />I Y I N Fee Current Y I N I <br />1 I <br /> <br />I Y IN <br />I <br /> <br />I Y IN <br />I <br /> <br />I Y IN <br /> <br />Fee Current <br /> <br />Y/N I <br />I <br /> <br />Y/N ,- <br />I <br /> <br />Y I N I <br />I <br />-',b."a:~i:.;;w":-~~v."'ii~;~~.j~ <br /> <br />Fee Current <br /> <br />Fee Current <br />