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<br />Jun 04 08 08:28a <br /> <br />Jay Brown <br /> <br />567-7340 <br /> <br />p.3 <br /> <br />Contact Phone Nbr <br /> <br />41" 1Q'lV <br /> <br /> <br />I 352-424-0906 <br /> <br />Date Received <br /> <br />I 6i3f200R <br /> <br />City of Zephyrhills Fire <br />Permit Application <br /> <br />Owner Addres.~ <br /> <br />Zephyrhills Elks Lodge <br />6851 Wire Rd. <br /> <br />Owner Phone <br /> <br />I <br />I <br /> <br />Owner Nwne <br /> <br />813 I I ?~2 I I 4~04 <br /> <br />Fee Simple Title Holder <br /> <br />I Titleholder Phone Nbr <br /> <br />II <br /> <br />I [ <br /> <br />Fee Simple Titleholder Address <br /> <br />lob Address <br /> <br />Subdivision <br /> <br />I 6'51 Wi", Rd <br /> <br />Lot Nbr. <br /> <br />Partel ID <br /> <br />o Bio-Hazard Waste Storage- ANNUAL <br /> <br /> <br />D Comm Exhaust Kitchen Hood - Duel <br /> <br />o Controlled Bum <br /> <br /> <br />D Emergency Generator <30 KW <br /> <br />o Emergency Generator> 30KW <br /> <br /> <br />D Fire Prote.::tioo Maintenance - Annual <br /> <br />D Fumigation Tent <br />o Hazardous Material (l.ier II or RQ Facility) Annual <br />o Hood Installation <br />D LP - Natural Gas Installation <br /> <br />LP - Natural Gas Annual Sale <br /> <br /> Qtrly Semi Anul Other <br /> Sprinkler 0 <br /> Fire AJal11l 0 0 0 0 <br /> Hood Cleaning D 0 0 0 0 <br /> Hood SupprcRsion I22r 0 ~ 0 0 <br />0 Fire alarm Installation D 0 0 0 0 <br />D Fire Pumps <br />0 Fire Works <br />D Flammable Application - Annual <br />0 Fuel Tanks <br />D Olber: J <br /> <br />B <br />D <br />D <br /> <br />Places of Assembly - Annual <br /> <br />Recreational Bun <br />Sparklers <br /> <br />Sprinkler System Installations <br /> <br />o Standpipes ( Sprinkler System) <br /> <br />D Torch Roofing <br /> <br />U Waste Tire Storage Annual <br />Valuation $1 <br /> <br />Contractor Sign <br /> <br />Company <br />Registered <br /> <br />Add ress <br /> <br />y <br /> <br />N I Fee Current I <br /> <br />Electrician Sign. <br /> <br />Address <br /> <br />License <br />Company <br /> <br />Registered <br /> <br />y <br /> <br />N I Fee Current I <br /> <br />Plumber Sign <br /> <br />License <br /> <br />Add ress <br /> <br />Company <br /> <br />Mechanical <br /> <br />Registered <br /> <br />y <br /> <br />N I Fee Current [ <br /> <br />Address <br /> <br />License <br /> <br />Other Sign <br /> <br /> <br />Address <br /> <br />18330 Lawrence Rd Dade City, Fl <br /> <br />Company <br />Registered <br /> <br />y <br /> <br />N I Fee Current I <br /> <br />I <br /> <br />Directions: <br />Fill out application completely. Company <br />Owner & Contractor sign back of application, notDriZe ( Or signed <br />Copy of contract with owner) Registered <br />If over $2500.00. a Notice of Commencement is reQuired <br />Mechanical work of ( $5000.00 ) requires a Notice of Commencent <br />Supply two (2) sets of drawings with applicable documentation <br />Allow 10 - 14 days f01 review after submittal <br /> <br />License <br /> <br />Security Fire Equipment, LLC <br />Y N I Fee Current <br />502552000220004 <br />