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<br />OCT/3l/2007/WED 02: 18 PM ZEPHYRHILLS BUILDING <br /> <br />813-780.0020 <br /> <br />Date Received <br />IIIr" IT <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />FAX No. 813-780-0021 <br /> <br />p, 002 <br /> <br />Fax-81S.780-0021 <br /> <br />City of.Zephyrhills Fire <br />Permit Application <br />Phone Contlctfor Pennlt L9 ~~~.jJ~~ <br />. ---Ll, ~hL1-t1_ . i1~ u <br /> <br />Owner's Phone Number I "3 I ~ I J 0kO I .I CD5D I <br />. ' <br /> <br />~4~ <br /> <br />I <br />[ <br /> <br />rr-.Il ,1'- ---; <br /> <br />-~y-Yhf I t~ ~ 1 Lot#. I ) <br />~ Parcel # .Iq;g~~~~<iiL~~~~;'~~/l31 <br /> <br />-~~~ 1L ~.Ll I LlI <br /> <br />Fee SImple TItleholder Nama <br /> <br /> <br />.3+h <br />jl <br />Fee Simple Titleholder Address _ <br />_ vV'" - --. /.;L... ~ ~ Ii <br />1 loll g -g.M ~e~ <br />lfbucc. ~ <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />~- <br /> <br />T ~\(~ <br /> <br />.D <br />D <br />D <br />o <br />ij. <br /> <br />D <br />D <br />.D <br />D <br />D <br />D <br /> <br />..,...,- <br /> <br />I . TItleholder Phone Number ! <br /> <br />II <br /> <br />II <br /> <br />D FumIgation Tent <br />D Hazardous Material (Tier II or R.Q Facility) ANNUAL <br />.0. Hood Installation <br />D LP/Natural Gas-Installatlon <br />D LPfNatural Gas-ANNUAL Sal9 <br />D Places of Assemb!y"ANNUAL. <br />D Recreational Bum <br />.0 Sparklers <br />D Sprinkler System Installations <br />D Standpipes (Sprinkler SY5) <br />D <br />D <br />I f")()Q .00 <br /> <br />Torch Roofing <br />Waste Tire storage ANNUAL ' <br /> <br />Valuation of Project <br /> <br />:--=- <br /> <br />.Ji n<r <br /> <br />Blo-Hazard Waste Storage - ANNUAL <br />Cornm Exhauat Kitchen HoodfDuct <br />Controlled Bum <br />. Emergency Gsnemtpr -< 30 kW <br />Emergency Gener<ltor :>0 30 kw <br />Fire ProtecUon Maintenance" ANNUAl.. <br />SprInkler D <br />Fire Alarm \gl <br />Hood ClearJSupprasslon 0 <br />Fire Alarm Installation <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAl.. <br />Fuel Tanks <br /> <br />other: <br /> <br />11 <br /> <br />... <br /> <br />V :~. <br /> <br />-1i~ <br /> <br />'-.I,Ii~r1 i _ <br /> <br />~ <br />Contractor <br />Signature <br /> <br />Address I <br /> <br />ELECTRICIAN [' <br />Signature I <br /> <br />Address I <br /> <br />PLUMaER I <br />Signature <br /> <br />AddresS [ <br /> <br />M, ECHA,NICAl.:1 <br />Signature <br /> <br />Address I I <br /> <br />~~~~:re~?~ ~ .' I. <br />~.- ~~~:J,~~.42 .~i!a(f4eJJ1n;l:l~,l- <br />Dueotions; <br /> <br />I <br />I <br />I <br />I <br />J <br />I <br />I <br /> <br />Fee Current ~L Y I N I <br />~ <br /> <br />Pee Current I Y I N I <br />I <br /> <br />Y IN I <br />I <br /> <br />I Y/N <br />r <br /> <br />I Y/N <br />I <br /> <br />I .Y IN <br />., <br /> <br />,f Y I N r Fee Gurrant <br />I <br /> <br />](5)N ] Fee Current GIN I <br />Lk:.C~_~~l~--,~~:"L . <br /> <br />-11.1~ <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 />Fee Current <br /> <br />company <br />Registered <br /> <br />L10ense # <br /> <br />Company <br />Registered <br /> <br />1..lcen66 # <br /> <br />LY/N I <br />r <br /> <br />~!lU.:~~ L <br /> <br />Fill out application completely_ . <br />Owner & Contractor sign back of appllcatlon, 'notarized (Or, copy of signed contract with owner) <br />If over $2500, a Nollce of Commencement Is required (Mechanical work over $5000) <br />Supply two (2) sets of drawlngs wIth applicable clocum9ntatlori <br />Allow 1 ~14 days for review after submIttal dati;!_ <br />