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<br />813-780-0020 <br /> <br />City ofZJphyrhills Fire <br />Permit IApplication <br /> <br />I Phone Contact for Permit <br />If ~ T ~ <br /> <br />.. <br /> <br />i~:;:~:~:~__~el,wm""",,,",l <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />Fee Simple Titleholder Name <br /> <br /> <br />Fax-813-780-0021 <br /> <br />Owner's Phone Number <br /> <br />l~Jw~~ ll5}2,~~Ll~~9__J <br />12?)3 II 'fFd-IJ6<?>7-~ <br />,-\d- <br />II II <br /> <br />Titleholder Phone Number <br /> <br />_ Ll ~ <br /> <br />t~ff~~~=..,...J- li ~~~n~~WW{fdJ!m~i1J~iW>r,~'lf;'~lli <br /> <br />Fee Simple Titleholder Address <br /> <br />G-ALL B)0C\ <br /> <br />Job Address <br /> <br />W.~"ii_1i'f.~ 'lI!~ T d!.. <br /> <br />'l'-t'-tq <br /> <br />Sub Division <br /> <br />2~V1~rh"t~ FL. <br />I I <br />I i Parcel# I <br />I <br />~r~~'lr~>~~ <br /> <br />gmm:U~~~1-lJJ~fJj~%'Zi;W1-w;t%'ii'BW..m:t~<<W>J1!lW'~i~~~l'~~r~~~f4 ~,~ ~ WBl..'m! <br /> <br />D <br />D <br />D <br />D <br />D <br />~ <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br />Comm Exhaust Kitchen Hood/Duct <br />Controlled Bum <br /> <br />Emergency Generator < 30 kw <br />Emergency Ge~erator > 30 kw <br />Fire Protection Maintenance - ANNUAL <br />Sprinkler <br /> <br />Fire Alarm <br /> <br />D <br />~ G(2.TL-~ <br />. scredu\ed <br />fDt q)I~}Dg <br /> <br />D <br />D <br />D <br />o <br />o <br />10 <br />'0 <br />o <br />D <br />o <br />D <br />D <br /> <br />D Fire Alarm Installation <br /> <br />D Fire Pumps <br /> <br />D Fire Works <br /> <br />D Flammable Application- ANNUAL. <br /> <br />D Fuel Tanks <br /> <br />D Other: I <br /> <br />};:n.~r.#:w'm1:i~iiht\!fJW~.l IlrAl~ t ~~ ! <br /> <br />~~~:~~:r ! ~~;;t - iJ"YHf ~!II <br /> <br />Address. p _ ----.i173_ IOf'rf4 f1- 33 ~8 <br /> <br />I <br /> <br />Hood Clean/Suppression <br /> <br />3354 <7-1 Lot# <br /> <br />(Utll AINt:U l-KUM I-'KUt-'t:K I Y I AX NU 11L;t:) <br />llmlm1l/.:O!io'1iillT!u;tTf1~:~.dh nl ~ !iHJiwt~~_mlmlV"~:r~~~~;~~,E' <br /> <br />. Fumigation Tent <br />Hazardous Material (Tier II 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 />Recreational Bum <br /> <br />Sparklers <br />Sprinkler System Installations <br />Standpipes (Sprinkler Sys) <br />Torch Roofing <br />Waste Tire Storage ANNUAL <br /> <br />/1~PO <br /> <br /> <br />Valuation of Project <br /> <br />... <br /> <br />I <br /> <br />'un)1 v--- _~!Ul.Ifi~~~~~~*~';: <br /> <br />I <br /> <br />~-0:7\ Vigil Inc. <br />~\.\. I~OOd 8e Exhaust Cleaning Svc. <br />\ ,--;// PO Box 273787 <br />\L.- Tampa, Florida 33688 <br /> <br />I <br /> <br />U <br /> <br />I I <br /> <br />OTHER I I Company <br />Signature I Registered Y IN' Fee Current I Y / N I <br /> <br />15'1~:1;:;~~~lJiiL;:"ti""'*W''''i0XU'''''''''9"",___'''_'1'",___.__~+L",,"'Ilillll''>,!;;i~~""""''''''''''''''''''''''''''>''''''''''","''''''~'''''''''C",,,,",,,,,,,J_;{;,!%;:Il'~'W!l;Slm' <br /> <br />Fill out application completely. . I <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 (Mechanif:;al work over $5000) <br />Supply two (2) sets of drawings with applicable documentation I <br />Allow 10-14 days for review after submittal date. I <br /> <br />Address I <br />MECHANICALI <br />Signature <br />Address I <br /> <br />I~ <br /> <br />Company <br />Registered <br /> <br />Y I N I <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y I N I Fee Current <br /> <br />Y/N <br /> <br />Company <br />Registered <br /> <br />Y/N <br /> <br />YIN <br /> <br />Fee Current <br /> <br />License # <br /> <br />Company <br />Registered <br /> <br />Y IN I <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />License # <br />