Laserfiche WebLink
L'J/ LUUU/ JU:V U. 10 :s. Lr.rninn1LLJ 15U1LUflV� r,4n No. 1� - '/ U P. 001 _ <br /> 893- 780 -0020 <br /> City oizephyrhills Fire • r 1 Fax-813-113o-002-1 <br /> Permit Application <br /> Date Date • <br /> Received <br /> Phone cftorPermit <br /> Owners Name 13 d r ) a-- 'd 13,g( 1 : <br /> Owner's phone Number <br /> Owner's Addres3 6 6 o e ' !3 4 2.-10 �� C ?nt,c, B��n zl t,:tic �� s�Ez <br /> • ..___ Fee Simple Titleholder Name. ` I <br /> Titleholder. phone Number (+ <br /> Fee Simple Titleholder Address I t <br /> Job Addresser g E1..6A. a--g . a, aJ C <br /> I r Lot# ! <br /> Sub Division = I I • f <br /> Q Blo- Hazard Waste Storage -ANNUAL. parcel # <br /> El ED Fumigation Tent <br /> Comm Exhaust Kitchen Hood/Duct I . I Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> LJ Controlled Sum Hood Installation <br /> • Lit Emergenc Generator < 39 kw r—� LP /Natural Gas - Installation <br /> ni Emergency Generator> 30 kw • t LP /Natural Gas - ANNUAL. Sale <br /> n Flee Protection Maintenance ANNUAL • • Places, of Assembly,ANNUAL • <br /> ry em .® • it 3 p, STA(LT <br /> Sprinkler ❑ ❑• ❑ MI a Recreational l3um b AT <br /> Fite Alarm ri ❑ ❑ Q n Sparklers • <br /> Hood Cleaning El CI e ❑( 1 d Sprinkler' System Installations 1 2 2 2 0 <br /> Hood Suppression . n ❑'' ❑ ' ❑ .I : 1 = Standpipes (Sprinkler Sys) q r ' 3 Q P N, <br /> Fire Alamr Installation <br /> Torch Roofing/Tar Kettle' <br /> IR <br /> Fire Pumps . Waste Tire Storage ANNUAL <br /> • <br /> Fire Works <br /> Flammable Application- ANNUAL <br /> . . • . <br /> 1 . ' • _ n Valuation of Project <br /> Fuel Tanks <br /> E Othcr <br /> Contractor <br /> Signature 1 .3 v <br /> Company � v S T4Ar•■ cject... :.. v.. <br /> Registered Fee Current / N <br /> Addree6 I (*$ - 74., -- t- QDOOS 4 sr% q P L Tt EL� <br /> ` . <br /> { ELECTRICIAN - �Z licaneb # <br /> Signature 1 Company <br /> Registered Y/ N I Fee Current 1 .Y / N 1 <br /> Address j <br /> License # <br /> PLUMBER I • <br /> Signature Company <br /> Registered Y/ N ._Fee Current I Y'/ N I <br /> Address 1 <br /> License # I_____.— <br /> MECHANICAL <br /> Signature Company I <br /> • Registered Y / N 1 Fee Current Y/. N <br /> Address I <br /> License # I <br /> oTHFR • <br /> Signature Company I <br /> Registered Y/ N I Fee Current I Y/ N I <br /> Address <br /> Dtrectiona: License # <br /> Flu out application completely, <br /> Owner & Contractor sign back of 4pplicatIon. notarized (Or copy of signed contract with owner) <br /> If over 52500, a Notice of Commencement is required.(Mechanicei work over 55000) <br /> Supply two (2) aids of drawings with applicable documentation <br /> Allow 10 days for review attar sut>rnittar date. Parcel # - obtained from Property Tax Notice (h ' <br /> tiP� //a PPre186r.paacogovcom) <br /> • <br />