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<br />813-780-0020 <br /> <br />Date Received <br /> <br />\ler's Name <br /> <br />Owner's Address <br /> <br />City of.2ephyrhills Fire <br />. Permit Application <br /> <br />I <br />I <br /> <br />:tP 1613 <br /> <br />Fax~13-780-0021 <br /> <br /> <br />Phone Contact for Permit <br /> <br />Owner'sPhoneNu~-1 78-3 1.1~7~71 J <br /> <br />Fuel Tanks <br /> <br />II <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br /> <br />Comm Exhaust Kitchen Hood/Duct <br /> <br />Controlled Bum <br /> <br />. Emergency Generator < 30 kw <br /> <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br /> <br />Sprinkler <br />Fire Alarm <br /> <br />Hood Clean/Suppression <br />Fire Alarm Installation <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />I Titleholder Phone Number I <br /> <br />II <br /> <br />Fee .Simple Titlehold~ Name <br /> <br />I <br />I <br />I 7' -3 ~ () .;}alf t3.8vJ. <br />I <br /> <br />Fee Simple Titleholder Address <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANIC' <br />Signature . <br /> <br />Address I <br /> <br />OTHER I <br />Signature <br /> <br />Address I <br />Directions: <br /> <br />I Lot# <br /> <br />I <br /> <br />Fumigation Tent <br />Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> <br />I Company <br />Registered <br />i License # <br />Company <br />Registered <br /> License # <br /> Company <br /> Registered <br /> License # <br /> Company <br /> Registered <br /> License # <br /> Company <br /> Registered <br /> Ucense# <br /> <br />Torch Roofing <br />Waste Tire Storage ANNUAL <br /> <br />l <br /> <br />Valuation of Project <br /> <br />Other: <br /> <br />fAt>T .sec~l("l9" Se'tV/ce.5 <br />c: Y 1 N I Fee CUrrent I Y I N I <br />I FF ~e~/J;l..~ I <br /> <br />I Y IN I Fee Current I Y I N I <br />I I <br /> <br />Y 1 N I Fee Current I Y 1 N I <br />I <br /> <br />Y/N I Fee Current I Y/N I <br />I <br /> <br />Y 1 N I Fee Current I Y I N I <br />J <br /> <br />~~:tuc:r I~..~ ~ <br />=::~'I?I hi, W..iep .AVo;, ~~~ <br /> <br /> <br />Address I <br /> <br />I <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />o <br />D <br />o <br />o <br />o <br />~ <br /> <br />o <br />D <br />D <br />D <br />D <br />D <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 />