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Ma' 26. 2010 11:12AM FIRE FIGHTER, INC No• 8245 P. 1 <br /> ., of Zephyrhills'Fir Fax -813- 780 -0021 <br /> . Permit Application <br /> .Date Received \ 0 I%y <br /> �� Ph one Contact for Permit r! <br /> ..:. -.. IV . /". CIA 1 1' .. ;,, .: : - ,. •._. -,,... .'.�. V�WNk ..-''� h Ytii �.. -, , o I • <br /> Owner's Name 1 - c11Vf Q-{�,j- 1 ( <br /> Go l 4 17 ,A4it L D , Owner's Phone Number . F Q) 3 ter 7 g <br /> _ iil C , ' <br /> Owners Address 1 - w >- \ C,1.Vb1"+Olr oft_ 1 (J <br /> Fee Simple Name I Titleholder Phone Number [ 1 1 i t I <br /> Fee Semple Titleholder Address . <br /> .��: , ., - ,•- :,:.,. �,_. ,,..., . < , , Belts fSaC x� <br /> Job Address : _ 3 L% 1 ti tat S.+- i t2 Lot # f <br /> Sub Division Parcel # <br /> _ .. _ d.�lai9kWti�tssri uef�3f <br /> D BIo- Hazard Waste Storage - ANNUAL Q Fumigation Tent <br /> 7 Comm Exhaust Kitchen Hood /Duct ED Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum El Hood Installation <br /> Q Emergency Generator < 30 kw 1 LP /Natural Gas- Installation <br /> E Emergency Generator > 30 kw 1 LP/Natural Gas- ANNUAL Sale <br /> r - 1 Fire Protection Maintenance - ANNUAL r1 Places of Assembly- ANNUAL <br /> r y l Utn <br /> Sprinkler n ❑ ❑ ❑ - E Recreational Bum <br /> Fire Alarm 71 CI ❑ M f 1 E Sparklers <br /> Hood Cleaning 0 ❑ [ 1 n Sprinkler System Installations <br /> Hood Suppression Z ❑ P ❑ I I Standpipes (Sprinkler Sys) <br /> 0 Fire Alarm Installation El Torch Roofing/Tar Kettle <br /> IR Fire Pumps L--J Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL I I Valuation of Project <br /> 1 - 1 Fuel Tanks <br /> Other: 1 1 <br /> Contractor , . Company e.__ <br /> Signature _ Ss , ii P Q1Vr ^- w�yI 77�� l , L � �.. Registered � j1 Fee urrent Y / N <br /> Address �e 1'�`!il�el�L'> • License# f j1SUSDoo ) <br /> ELECTRICIAN Company <br /> Signature , Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # ( ( <br /> PLUMBER Company 1 <br /> Signature Registered Y / N 1 Fee Current I Y/ N I <br /> Address l 1 License # I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N 1 Fee Current I Y / N I <br /> Address r _1 License # 1 <br /> OTHER Company —1 <br /> Signature Registered HN 1 Fee Current I Y/ N I <br /> Address License # <br /> Directions: m.y.�k rm.uc <br /> FIII out application completely. <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> If over 52500, a Notice of Commencement Is required.(Machanical work over 55000) <br /> Supply two (2) sets of drawings with applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (help: / /appralser.pascogov.com) <br />