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<br />ZEPHYRHILLS BUILDING FAX No. 813-780-0021~g? P.OOl <br />City of.Zephyrhllls Fire .-tf FaX-813-780-OO21 <br />PermIt Application . <br />"~te R~~e.!.v~i _ j.L".........V'r---'-'" ..__~ I ,_ . p~~ntact for PermIt -lJ~J-'r++-~~~ll.~~~L~ <br />'I~\".)~ c. "" ~Ul 0 I OWners PhcrIQ Numher I II ' . I L <br />12.k052~t'. ~'M\-C,~~ pl ~38D~ <br /> <br />Ii "I Ti1l,hol'oc Phon, _be< I II II <br />Fee Simple Titleholder Address' . ::. :~; <br /> <br />==-~-~-:4~~J.;~M~~~LV;~;;; ;- --:~;-:~ <br />sub Division _ _ _ _ I Parcel # ll\-- Z~.. 11 -~~~ ~a~ - 9 l~ <br />. (U 1 "r=,~KU r=,1"I. rli I II,,; <br />~ t""'......~1 -..IlII!:":I....-- - ._.!!j! 11 1 .."" . .!lfi!J ~ ~1RlP"", """,-..A:1ll~II!" r~ <br /> <br />,D BID-Hazard Waste Storage - ANNUAL <br /> <br />D Comm Exhaust Kitchen Hood/Ouct ' <br /> <br />D Controlled Bum <br /> <br />D ,Emergency (lenerator <: 30 kw <br /> <br />D <br />. <br /> <br />D Fumlgatlon Tent <br /> <br />D <br />D Hood Installation <br />D LP/Natural Gas-Installation <br />D LP/Natural Gas-ANNUAL Sale, , <br />o Places of A~$emhly-ANNUAl.. <br />o Recreallonal Bum <br />D Sparklers <br />D Sprinkler System Installations <br />D StandpIpes (Sprinkler Sys) <br />D Torch Rooting <br />D . Wasw Tire Storage ANNUAL <br /> <br />r <br /> <br />OCi/ll/2007/THU 01: 11 PM <br /> <br />B13-7BO-0020 <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />Fee Simple Titleholder Name <br /> <br />Hazardous Material (Tier II orRQ Facility) ANNUAL <br /> <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />, , <br /> <br />D. <br />o <br />,D <br />D <br />D <br />D <br /> <br />Sprlnkler <br />,Fire Alal11l <br />Hood Clean/Suppression <br />Fire Alal11l Installation <br /> <br />D <br />. <br />o <br /> <br />Fire Pumps <br /> <br />Fire Worl<s <br />Flammable Application- ANNUAL <br /> <br />Fuel Tank.. <br /> <br />1 <br /> <br />Valuation of Project <br /> <br />Other: <br /> <br />';'~_l ~ddr~sL':::~~':'~_~_~~"RI'I~~ -").. <br />Directions: . <br />Fill out application completely. <br />owner & COntractor sign back of application, notarized (or. copy of signed contract wi1l1 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 /> <br />Contractor <br />Signature <br /> <br /> <br /> Company <br /> Registered <br /> Licen.,e # <br /> C~mpany <br /> Registered <br />I License # <br />l Company <br />Registered <br />J License # <br />I Company <br />Registered <br />I LIcense # <br />I Company <br />Registered <br /> <br />ELECTRICIA <br />Signature <br /> <br />Address I <br /> <br />I <br /> <br />PLUMBER <br />Signature <br /> <br />Addre510 I <br /> <br />MECHANICA~ <br />Signature <br /> <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />- <br /> <br />J. Ucan:ss # <br />...-.. _.il LlIlllillP__ r r <br /> <br />I CtJiplrJlrfla I i:..W t/ flj,!!1IIL1n/CdJ/~J b,(.. <br />. Ct.X N J Fee Current ~ · . <br />1C:r:~"i'5' I . <br /> <br />I Y/N <br />I <br /> <br />I. Y/N <br />.\ <br /> <br />I Y l N r Fee Current <br />I <br /> <br />I Y/N I Fee Current I Y/N I <br /> <br />L.~_~__~~~ ...." _, <br /> <br />Fee Current I <br /> <br />Y/!iJ <br />I <br /> <br />Y IN I <br />I <br /> <br />Fee Current <br /> <br />-= <br /> <br />Y/N/ <br />I <br />