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<br />OCT/I1/2007lTHU .01: II PM <br /> <br />813"780-0020 <br /> <br />Date Received <br />"" iTff Ill; ... <br /> <br />OWner's Name <br /> <br />Owner's Address <br /> <br />ZEPHYRHILLS BUILDING <br /> <br />FAX No. 813-780-002111- rot ~O <br />CIty of.ZephyrhJIIs Fire 11 <br />Permit Application <br /> <br />P. 00 I <br /> <br />Fax-B13-78CHlO21 <br /> <br />- - <br /> <br />1I.~ <br /> <br />_~ne Co~~~..r.o..r.!:~~~ t1~J...Jl~Jl:l~L.. <br /> <br />Owner's PhCr!A Number I II ' I J <br /> <br /> <br />II <br /> <br />II <br /> <br />Titleholder Phone Number <br /> <br />Fge Slmple Titleholder Name <br />Fae Simple TItleholder Address <br /> <br />Job Address <br /> <br />~t4~-~___IJ <br /> <br />noth <br /> <br /> <br />Ad=:J ~SIIlED . <br />~. ~ ;.u...':lIII.,.... '""~'QIl~ Ttr~- -...a;.}......_-r. <br />Directions: . <br />Fill out application completely. <br />Owner 8: COntractor sign back of application, notarized (Or. copy of signed contract with owner) <br />If OVer $2500. a Notice of CommanCGmant 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 /> <br />Sub DIvIsion <br /> <br />~"'1J11~J I <br /> <br />Contractor <br />Signature <br /> <br />ELECTRICI <br /> <br />Signature <br />Address I <br /> <br />I <br /> <br />PLUMBER <br />Signature <br /> <br />AddreslO I <br /> <br />M!;CHANICAi <br />Signature <br /> <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />:l.. <br /> <br />: ~ lIiIIIIIlll!.,. L III III r 1 "" ...... -..-............. ~ .4iil'Ml'" , ..""."jO ..."'!.lllli! W I Onv.l <br /> <br />f\'i~ L~P;4!.hill<, R 3~D. ~ 11.01.. 1141-~ <br />, . . ~ ParceJ# Ult~,~!~-~t';u91~~te) <br /> <br />IU! r _~t~~l l~~ <br /> <br />~~~s <br /> <br />,,~ ~u ~lr ~~Jl Ii <br /> <br />~-I--.i. -~~- <br /> <br />- ""'-~F <br /> <br />D <br />D <br />o <br />D <br />D <br />. <br /> <br />D <br />D <br /> <br />D' Hood Insta:iatlon <br /> <br />D <br />D <br />. 0 Places of A~sembly-ANNUAL <br />D Recreational Bum <br />D Sparklers <br />D Sprinkler Systarn Installations <br />D StandpIpes (Sprinkler Sys) <br />D Torch Roofing <br />D Waste Tire Storage ANNUAL <br /> <br />r <br /> <br />( <br /> <br />~s <br /> <br />Blo-Hazard Waste Storage - ANNUAL <br />Comm !;xhaust Kitchen Hood/Duot <br />Controlled Burn <br />. Emergency Clanerator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Malntanance - ANNUAL <br />sprtnkler D <br />,Fire Alarm . <br />Hood Clean/Suppression 0 <br />FJre Alarm Installation <br /> <br />Fumigation Tent <br />Hazardous Material (Tier II or RQ Facilily) ANNUAL <br /> <br />. <br /> <br />LP/Natural Gas-Installation <br />LPJNatural Gas-ANNUAl Sale, , <br /> <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tank.. <br /> <br />I <br /> <br />Valuation of Project <br /> <br />Other: <br /> <br />Company <br />RegIstered <br /> <br />Licens9 # <br /> <br />I CQDvnlt'fra' t:j.y( .G:xn.Mu~fCQliC>>1S #n<- <br />'. CD/ N _. Fee Cummt ,LV I t! ,. , <br />[t1 cxx:o .,gS- I . <br /> <br />I Y / N Fee Current I Y i N I <br />I I <br /> <br />I.. Y I N I Fee Current Y I N I <br />'I I <br /> <br />I Y I N I' Fee Current Y IN I <br />I := I <br /> <br />I Y I N I Fee Current <br /> <br />C~mpany <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 />Registered <br /> <br />Y IN I <br /> <br />---~"1oIlil~~~# ~[_:_------ '"_''''~~''' "'~_I.""J~ <br /> <br />~ Pl~ ...................,lIIIDI <br />