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<br />813-780-0020 <br /> <br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />Fee Simple Titleholder Name <br /> <br />City of Z~phyrhills Fire <br />Permit lApplication <br /> <br /> Phone Contact for Permit <br /><.. ,I I Owner's Phone Number II II <br /> I Titleholder Phone Number II II <br /> <br /> <br />- .;;J6rD tr <br />. : M~">+ l-\ea.-\~ ~ <br />7oSo 60l.J..JL l~urG <br />I <br />I <br /> <br />17050 <br />I <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />X ax-813-780-0021 <br /> <br /> <br />&/1 <br /> <br />/3 ( <br /> <br />Parcel # <br /> <br />I Lot# <br /> <br />!3CS-25-21.-OO\O -ID5o::J"~ <br />(Uti I AIN~U I-KUM t-'KUt-'~K I Y I AX NU J Il;~) <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />D <br />D <br />D <br />o <br />o <br />0' <br /> <br />o Fumigation Tent <br />o Hazardous Material (Tier II or RQ Facility) ANNUAL <br />o Hood Installation <br />. 0 LP/Natural Gas-Installation <br />o LP/Natural Gas-ANNUAL Sale <br />o Places of Assembly-ANNUAL <br />o Recreational Bum <br />o Sparklers <br />o Sprinkler System Installations <br />o Standpipes (Sprinkler Sys) <br />o Torch Roofing IrllrL ~.e: <br />o Waste Tire Storage ANNUAL <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br /> <br />Comm Exhaust Kitchen HoodlDuct <br />Controlled Bum <br /> <br />Emergency Generator < 30 kw <br /> <br />Emergency Generator> 30 kw <br /> <br />Fire Protection Maintenance - ANNUAL <br /> <br />Sprinkler D <br /> <br />Fire Alarm D <br /> <br />Hood Clean/&tt~I'" 6!!i01' D <br />\\Dot) ~~~ -1 <br />Fire Alarm Installation t::J <br /> <br />Fire Pumps <br />Fire Works <br /> <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />Valuation of Project <br /> <br /> <br /> <br />Contractor <br />Signature <br />Address I <br />ELECTRICIANI <br />Signature . <br />Address I <br />PLUMBER <br />Signature <br />Address I <br />MECHANICALI <br />Signature . <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />I <br /> <br />Other: <br /> <br />k~ <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 />Company <br /> <br />Registered <br /> <br />License # <br /> <br />Company <br /> <br />Registered <br /> <br />License # <br /> <br />-""lUll! --I. <br /> <br />......~ff~J!&tl~r <br /> <br />"l:i~~ <br /> <br />::Xf'rlVf~ b-rl n ~ '( <br />Y I N Fee Current I Y I N <br /> <br />Y I N I Fee Current Y I N <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />YtN <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y I N I Fee Current <br /> <br />Y/N <br /> <br />Address <br /> <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 (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 />