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<br />813-780-0020 <br /> <br />Date Received . <br /> <br />k~=ti@.l1~\.. <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />, <br />City ofZ~phyrhills Fire <br />Permit ~pplication <br />~~ O~(J~ I <br />IL-I1Y..LO ~ VttTtt <br />I ;2304 forO H?t(; t11!{(J(. <br />I <br />I <br /> <br />IC+lINtt WOK <br />I <br /> <br />4f 7 fir 7 <br /> <br />Fax-813-780-0021 <br /> <br />Phone Contact for Permit <br /> <br /> <br /> <br />I Owner's Phone Number I g f 3 <br /> <br />1((jSKI/I/ +l 335'70 <br /> <br /> <br />I Titleholder Phone Number I <br /> <br />1,1 Sf> I J 'l3S/ I <br />I <br />I <br />I <br /> <br />i <br />PLI <br /> <br />II <br /> <br />II <br /> <br />Fee Simple Titleholder Name <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />I ~~AI:~~~::K~:~AA NUI~CEJ <br /> <br />z~t:1# <br />I <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />F' <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br />Comm Exhaust Kitchen Hood/Duct <br />Controlled Bum <br /> <br />D <br />D <br />D Hood Installation <br />D 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 />i D Sprinkler System Installations <br />D Standpipes (Sprinkler Sys) <br />I D Torch Roofing <br />I D Waste Tire Storage ANNUAL <br /> <br />: I <br />ClCt171l1IT' CLc7fA//NG <br /> <br />Fumigation Tent <br />Hazardous Material (Tier II or RQ Facilitt) ANNUAL <br /> <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 /> <br />Fire Works <br /> <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />Valuation of Project <br /> <br />Other: <br /> <br />Ie OMf"LtTE <br /> <br />Co_om, ! ~ 0/- i ! Company I t/#/[!f->'C S~tIIC'E.:r <br />Registered Y I N Fee Current Y I N I <br />Signature I I <br />Address License # <br />ELECTRICIANI Company I <br /> Registered Y/N I Fee Current Y/N I <br />Signature <br />Address I License # I I <br />PLUMBER Company I <br />Signature Registered Y/N I Fee Current Y/N I <br />Address I License # I I <br />MECHANICALI Company I <br />Signature Registered Y/N I Fee Current Y/N I <br />Address I License # I I <br />OTHER Company I <br />Signature Registered Y/N I Fee Current Y/N I <br />Address License # <br />Directions: <br /> <br />Fill out application completely. I <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 (Mechanipal work over $5000) <br />Supply two (2) sets of drawings with applicable documentation <br />Allow 10-14 days for review after submittal date. I <br />