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6 geo <br /> .... City of 2ephyr <br /> (' Fax -813- 780 -0021 <br /> g1 7so -DD2o Fire permit Application <br /> Phone Contact for Permit 1 gr/ 3 1 9! 6 I6 y6 f. <br /> Dat Received t <br /> Own er s N // Owners Phone Number <br /> Owner's Name f"✓ ' ^ ' 6 r�G <br /> Owner's Address S <br /> 6 .g/v i 3351/ 1 1 <br /> - titleholder Phone Number <br /> Fee Simple Titleholder Name <br /> Fee Simple 'Titleholder Address 1�s — °".� K ":� r <br /> : .. ,. 6iv6/ 2e X ‘,// G/ 3y > Lot# <br /> Job Address ��� --.4? �� <br /> Parcel # <br /> R4a„ <br /> Sub Division" <br /> 1 C Fumigation Tent <br /> 1 Bio-Hazard Waste Storage - ANNUAL <br /> Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> 1 I Comm Exhaust Kitchen Hood /Duct j Hood Installation <br /> 1 - Controlled Bum C <br /> LP /Natural <br /> Gas - installation <br /> 1 Emergency Generator < 30 kw � LP /Natural Gas - ANNUAL Sale <br /> 1 � Emergency Generator> 30 kw � places of Assembly- ANNUAL <br /> J Fire Protection Maintenance - ANNUAL <br /> � Icltrlyl ' e <br /> b rm ( <br /> � <br /> 7 � � Recreational Bum <br /> Sprinkler <br /> Fire Alarm 1 <br /> 1 ID 0 ID I 1 1 Sparklers <br /> 71 Sprinkler System Installations <br /> Hood Cleaning El ID CI <br /> o �' 0 I ( Standpipes (Sprinkler Sys) <br /> Hood Suppression 1 <br /> 1 1 Torch Roofing/ Tar Kettle <br /> 1 Fire Alarm Installation I Waste Tire Storage ANNUAL <br /> Fire Pumps <br /> 1 1 Fire Works Valuation of Project <br /> 1 I Flammable Application- ANNUAL 111111.1111111111111 <br /> 1 1 Fuel Tanks <br /> Other: 1 <br /> Company .I <br /> Contractor l Registered i L Y/ N I Fee Current Y/ N Signature I • Address I 1 - License # <br /> Company <br /> Signature nature 1 <br /> ELECTRICIAN Registered Y / N 1 Fee Current i Y / N 1 . <br /> I 1 1 <br /> License # <br /> Address 1 . <br /> Company <br /> PLUMBER Registered E Y / N 1 Fee Current 1 Y / N <br /> Signature 1 <br /> Address 1 License # <br /> 1 Company <br /> MEnature g <br /> ALI I Registered 1 L Y / N I Fee Current Y / N <br /> • Signature I! <br /> -License # <br /> Address 1 <br /> OTHER Company <br /> Registered Y/ N 1 Fee Current 1 Y/ N <br /> Signature <br /> Address License # <br /> Directions: <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 raiser. asco ov.com <br /> htt !fa <br /> Allow 10 -14 days for review after submittal date. Parcel # - obtained from Property Tax Notice ( p pP P g ) <br /> • <br />