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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 />bJ-' Oil & <br /> <br />, <br />City ofZ~phyrhills Fire <br />Permit IApplication '1)ou~ <br /> <br />I Phone Contact for Permit <br /> <br />I -, :'0<'6. <br />I ~{l~ LLC <br />i 3i3L;~ GW~ <br />I <br />I <br /> <br />I I Owner's Phone Number <br /> <br />,-~ <br /> <br /> <br />i I Titleholder Phone Number <br />I <br />I <br /> <br />Fee Simple Titleholder Address <br /> <br />Fax-813-780-0021 -- <br /> <br /> <br />117f":2. <br /> <br />I J ,,7l.j <br /> <br />%).3 <br /> <br />II <br /> <br />II <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />Clu.b'nol' l)L -\l\-\-chtJ-~V'"'t I Lot# <br /> <br />Parcel # 1/..2- ,;;lee -~ 1- oec5,?}. - 00300 - ClOC'C <br />(Utl, A'Nt::U I-KUM t-'KUt-'t::K I Y 'AX NU 11t;t::) <br /> <br />3 9 3Y~ <br /> <br />c:e 7t-1 ~ <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />D <br />D <br />D <br />D <br />D <br />o <br /> <br />Contractor <br />Signature <br /> <br />Address <br /> <br />ELECTRICIAN <br />Signature <br /> <br />Address I <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br />Signature . <br /> <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />o Fumigation Tent <br />I 0 Hazardous Material (Tier II or RQ Facility) ANNUAL <br />I 0 Hood Installation <br />o 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 />~ 0 Standpipes (Sprinkler Sys) <br />110 <br />Torch Roofing <br /> <br />1'0 <br />Waste Tire Storage ANNUAL <br /> <br />I <br />I I ;J, '3 y (': 66 I Valuation of Project <br />f\ro C:J."2~ t 0.f2A.. cn~ Hf-e $vr"'(to~~\~ <br /> <br />Bio-Hazard Waste Storage -ANNUAL <br />Comm Exhaust Kitchen Hood/Duct <br />Controlled Bum <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 />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />Other: <br /> <br />I-::rv,~\\~~ eP <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />I $.) .,,('~~ ~'i ("" t> <br />Y I ~ Fee Current <br />I <br /> <br />I Y I N I Fee Current <br /> <br />I <br /> <br />I Y I N I Fee Current <br /> <br />I <br /> <br /> <br />I . Y I N I Fee Current <br /> <br />I <br /> <br />I Y I N I Fee Current <br /> <br />~L~-/ 1)ctX' <br />, ( ) <br />f'JOC" - f'-.J 1+ <br />~-+o ~fM l("'" <br /> <br />t=-Ce~ <br />Y IN I I <br />I <br /> <br />Y IN I <br />I <br /> <br />~.~. <br />:1 <br />I <br /> <br /> <br />Y/N <br /> <br />'Y/N <br /> <br />Y/N <br /> <br />Address License # <br /> <br />Directions: I <br />Fill out application completely. 1 <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. I <br />