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<br />'813-780-0020 <br /> <br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />City of Zephyrhills Fire <br />Penn it Application <br />, Phone Contact for Pennlt <br />TERRY ANDERSON / ANDERSON PRESST$~ Number <br />5104 MURRAY HIlL DR. TAMPA. FL. 33615 <br />I Titleholder Phone Number <br /> <br />Fax-813-780-0021 <br /> <br />JJ <br />11884 <br /> <br />LJ <br />I /5208 <br /> <br />813 <br /> <br />II <br /> <br />II <br /> <br />Fee Simple Titleholder Name <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />1 Lot# <br /> <br />Sub Division <br /> <br />GOLDEN CORRAL 6855 GALL BLVD. ,ZF.PHYRHTT.T.S, FT. ii~L..7-757h <br /> <br /> <br />I Parcel # I <br />(Uts I AINcU I-KUM I"KUt"t:K I Y I AJf. NU II!,,;!:) <br /> <br />o <br />[XK] <br />o <br />D <br />o <br />o <br /> <br />o <br />o <br />o <br />o <br />o <br />o <br /> <br />Bio-Hazard Waste Storage - ANNU~I fJt!! J I( <br />Comm ExhSust KItchen HoodIDuCl -;:O!2- <br />Controlled Bum -r vwt/ ~ <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Flre Protection Maintenance - ANNUAL <br />Sprin~er r::J <br />Fire Alann r::J <br />Hood Clean/Suppression r::J <br />Fire Alann Installation <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />D Fumigation Tent <br />o Hazardous Material (Tier" or RQ Facility) ANNUAL <br />D Hood Installation <br />D LPlNatural Gas-Installation <br />D LP/Natural Gas-ANNUAL Sale <br />o Places of Assembly-ANNUAL <br />o Recreational Bum <br />o Spar1ders <br />D Sprinkler System Installations <br />o Standpipes (Sprinkler Sys) <br />D Torch Roofing <br />D Waste Tire Storage ANNUAL <br /> <br /> <br />Fuel Tanks <br />Other: <br /> <br />I Valuation of Project <br /> <br />Co~~r. f"" . "",. "~.," .... - -r.' ...'\ ", I Company <br />~... ' "'.... . I I <br />Signature Registered Y/N Fee Cummt Y/N <br /> - }'.~ ..,.... 4i... <br />Address I ~. ., I I <br /> License # <br />ELECTRICIANI I Company <br />Signature Registered Y/N I Fee Current Y/N I <br />Address I I License # I <br />PLUMBER I Company <br />Signature Registered Y/N I Fee Current Y/N I <br />Address I I License # I <br />MECHANICAlI I Company <br />Signature Registered Y/N I Fee Cummt Y/N , <br />Address I ".:~l,' I License # I <br /> . <br />OTHER I I Company <br />Signature Registered Y/N Fee Current Y/N I <br />Address tt-, I License # ,I <br />Directions: ~ ni~' ~. . ~r <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 wfth applicable documentation <br />