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<br /> <br />Fee Simple Tltlehplder Name I Tllleholdtir Phone Number l . II. II ,I <br />I='ee Simplelltleholder Address ~ : ~: ~~ <br /> <br />=~. '~E4jA r.:U'~\\lr~\j'~'~~~\"-' ---?=""rJ <br /> <br />~"'," _~... "',,- ~ ~ - ~~ _.1 . ~=,. ~.l '~""'. --..::.,-. "._..J <br />D Blo-Hazard Waste Storage -ANNUAL 'D Fumigation lent ' <br />D Comm 8<haust Kitchen Hood/Duct D HElzardous Malerlal (Tier II or RQ Facility) ANNUAL <br />D Controlled B\.lm D Hood In~lal\atlon <br />o E:mergency Generator < 30 kw D LPjNatUfBl Gas-Inatallatlon <br />. D . Emergency Generator" 30 kw D LP/Natul<\l Gas-ANNUAL SlIle <br />IV1 Flrt'l Prot~tion Malnt..nence -ANNUAL D Places of A~~0mbly-AIIlNUAL ~~\ . , \ ~d <br />lp '1V1 ~(JY I::>eoiiiil ~ ~ 0 -~ <br />Sprinkler CJ ,..... L-J Recreational Bum 'fu-- \ \5\ ffi, <br />Fire Alarm 0 0 0' o' [=:=J D Sparlders . <br />O r-1 D //'" <br />o 0 [J L-..J Sprinkler SY"lem Installations ./ ) <br />o POD c:=l 0 Standpipes (Sprinkler Sys) // (') I q I j <br />D Torch Rootingrrar Kettle ~ 7) / <br />D Waste Tire Storage ANNUAL ~/ <br /> <br />1 .1 ' Valuation 0 ' --- <br /> <br />MAP/28/2007/WED 07:20 AM <br /> <br />ZEPHYRHILLS BUILDING <br /> <br />813-780-0020 <br /> <br />City of.zephyrhllls'Firec <br />Permit Application <br /> <br />Date Received <br /> <br />Owner's Name <br /> <br />Owner'll Addre~ll <br /> <br />Hood CleElning <br /> <br />Hood SuppressIon <br /> <br />~ <br /> <br />D <br />"...'--~-"llI.,.-"'" <br /> <br />I <br /> <br />Fire Alarm lri~tellation <br /> <br />Fire pl.lJT1pS <br /> <br />Fire Workll <br />Flemrmable ApplicatIon- ANNUAL <br /> <br />Fuel Tank6 <br />Other: I <br />~'lj <br /> <br />FAX No. 813-780-0021 <br /> <br />P. 001 <br /> <br />Fax..1113-780-0021 <br /> <br />'I! <br /> <br />- .:.'!~ <br /> <br />I <br />Phone Contactfor Permit <br /> <br /> <br />Owner':; Phone Number <br /> <br />11'I~2. I '~ <br /> <br />"iltilll1Il!.l.... i <br /> <br />Wl!t:eIJ.U.~ <br /> <br />'~ <br />-r-"~' '---~"'f'~~ <br />, , I <br />Fc;eCurrant 1 . Y / NI <br />I <br /> <br />"<:y--~lll- <br /> <br />Contractor <br />Signllture <br /> <br />Address I <br /> <br />ELECTRICIANL <br />Signature <br /> <br />Address I <br /> <br />PLUMBER <br />SIgnature <br /> <br />Address [ <br /> <br />MECHANICAL <br />Signature <br />Addre5~ <br /> <br />OTHER <br />Signature <br /> <br /> <br />Addrelils <br /> <br />DirectionS: <br /> <br />I <br />I <br />I <br />I <br />I <br />J <br /> <br />~!:I! ,.......,It!'f4] ~~I~ <br /> <br />Company ~ <br /> <br />Registered <br /> <br />Y/N <br /> <br />l.icense # <br /> <br />L <br /> <br />l Y/N <br />I <br /> <br />ty IN~ <br />I <br /> <br />I Y/N <br />I <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Company <br />Reglsterei:l <br /> <br />Fea Current. <br /> <br />Y/IiJ <br />I <br /> <br />License # <br /> <br />J <br /> <br />Company <br />Registered <br /> <br />L1cenee # <br /> <br />ComplIny <br />RegIstered <br /> <br />License # <br /> <br />Y/N <br /> <br />Fee Current <br /> <br /> <br />Company <br /> <br />Registered <br /> <br />LIcense # <br /> <br />1='111 out IIPplication comple~ly, <br />Owner & Contrllctor sign baak of application, not3r1~d (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) sats of drawings with applicable documentlltlon <br />Allow 10-14 days for revieW after submittal date. Psrcel #. obllllned from Property TaX Notice (http://appraiser.pascogov,com) <br />