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<br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />City of ZJphyrhills Fire <br />Permit \A.pplication <br />I <br />Phone Contact for Permit <br /> <br />1fBcH9 <br /> <br />Fax-813-780-0021 <br /> <br />8~ 3-7~O-0020 <br /> <br /> <br />1L?'A'/l/.5 S/J/17/1 <br />..:5dI. S- /l ~ // t.. ,p 0 .r", <br /> <br />Owner's Phone Number 17.;) 7 117?t- I Vt ~3 <br />ceo' -rAL)Pf:/A.) S/R/"OC.S C&.. 3y~crr ~('N1rt.'S <br /> <br /> <br />Fee Simple Titleholder Name <br /> <br />Fee Simple Titleholder Address <br /> <br />1'1 <br /> <br />II <br /> <br />Titleholder Phone Number <br /> <br />~c,,~ <br /> <br />64t...L <br /> <br />Sub Division <br /> <br />~t.-v'p < ;;Z E- rt/"//!#rL.t-.f',ct... 33S'VJ-. <br /> <br />Lot # <br /> <br />Parcel # <br /> <br />(UtlIAINt:U I-KUM t-'KUt-'t:KI Y lAX NUIIGt:j <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 />Address <br /> <br />D Bio-Hazard Waste Storage - ANNUAL <br />D Comm Exhaust Kitchen Hood/Duct <br />D Controlled Bum <br />D Emergency Generator < 30 kw <br />D Emergency Generator> 30 kw <br />D Fire Protection Maintenance - ANNUAL <br />Sprinkler D <br />Fire Alarm D <br />Hood Clean/Suppression 021 ..5" €-h ( /1"',.)' <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br />I~-/ <br /> <br />Fire Alarm Installation <br /> <br />Fire Pumps <br /> <br />Fire Works <br /> <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />o <br />o <br />D <br />o <br />o <br />o <br />10 <br />o <br />o <br />o <br />D <br />D <br /> <br />Fumigation Tent <br />Hazardous Material (Tier \I or RQ Facility) ANNUAL <br />Hood Installation <br /> <br />LP/Natural Gas-Installation <br />LP/Natural Gas-ANNUAL Sale <br />Places of Assembly-ANNUAL <br /> <br />Recreational Bum <br /> <br />-:.J'Dc; SC 11 Ct)U t..-U) <br />-,.( <br />J V L Y rJ-? J.....o o,F' <br />, <br /> <br />Sparklers <br />Sprinkler System Installations <br />Standpipes (Sprinkler Sys) <br />Torch Roofing <br />Waste Tire Storage ANNUAL <br /> <br />I .y;2-S:- n; <br /> <br />Valuation of Project <br /> <br />Other: <br /> <br />~w/C,L <br /> <br />I <br />I <br />I <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 />Company <br /> <br />Registered <br /> <br />License # <br /> <br /> <br />Gt.e:I'l.t/,.,'t;. of 7/?,t1/. <br /> <br />Fee Gurrent I8l1loj.fl c:-- <br /> <br />I <br /> <br />Y I N I <br />I <br /> <br />Contractor <br />Signature <br /> <br />A<kI~" t::'H~ <br /> <br />ELECTRICIAN <br />Signature <br /> <br />Address I <br /> <br />Job Address <br /> <br />A/f1.4t-OClJ'A <br /> <br />,IC,J . I /l~~ Sr~.{ <br /> <br />. . <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y I N Fee Current Y I N <br /> <br />.. .~. ". '. ,... ... ~l <br /> <br /> <br />Y I N I Fee Current Y I N I <br /> <br />Directions: <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 $5000) <br />Supply two (2) sets of drawings with applicable documentation I <br />Allow 10-14 days for review after submittal date. <br /> <br />.$..., QlJ <br />....:)0. <br />