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<br /> 813-780-0020 City of Zephyrhifls Fire Fax-a�saao-ooz�
<br /> Permit Application
<br /> Late Rece�ved Phone Contact for Pertnit
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<br /> Owner's Name �(� �'7�(J$//�((p �OC-UT�bKS OwnePS PhOne Number � � �J
<br /> Owner's Address �� �blC �/� L U7Z L 77,j y0 �6l/d
<br /> Fee S�mpie Trtieholtler Name Trt1eh01der PhOne Number C� C� �
<br /> �r�S�mpie Titleholder Atldress
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<br /> Sub�ivision �,���
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<br /> � Bio-Hazard Waste Storage-ANNUAt a Hazardous Material(7ie�II w RQ Facility)ANNUAL
<br /> � Comm Exhaust Kitchen HpodlDuct � Hood In5ta11ati0n
<br /> � Conuoiled Bum , � LP/Natural Gas-Instatiation
<br /> � Emergency Generator<30 kw � LP/Naturei Gas-ANNUAL Sale
<br /> � Emergency Generaior>30 kw � Places of Assembly-ANNUAL
<br /> � Fire Protection Maintenance•ANNUAL a Recreatlonal Burn
<br /> Sprinkler �L"',ep p' � ef � Sparklers 3� � �
<br /> Fire Alarm � ❑ � O � � Sprinkler System Instailations ��
<br /> Hood Cleaning � ❑ O � � � Sffindpipes(Sprinkler Sys)
<br /> Hooc Suppression � p ❑ Q � � Torch ftoofing/Tar Kettle
<br /> � Fire Alarm Installation a Weste Tire Storage ANNUAI
<br /> n Fire Pumps
<br /> �� Fire Works
<br /> � Flammable Appiicatiorn ANNU/u. ""�"'�'�'-"
<br /> ❑ Valuation of Proiect
<br /> Fuel Tanks
<br /> ❑ Other:
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<br /> Signature ���y �� � �u�'1'O r�
<br /> Registerod Y/N Fee CuRent Y/N
<br /> Address 3 5 31 1�e �.�yn� Ra, �roense# F
<br /> '_LtCTRICIAN OO �Il
<br /> `;ignat�re
<br /> Company
<br /> Re9istered Y/N Fee Current Y/N
<br /> �hdress
<br /> License#
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<br /> Company
<br /> s�g�a�ure � Registered Y/N Fee Current Y/N
<br /> Address
<br /> License# `l
<br /> MECNANICAL
<br /> S�gr,ature
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<br /> Registered Y./N Fee Currznt Y J N
<br /> Aodress �
<br /> License�
<br /> OTHER
<br /> Sign�ture
<br /> Company
<br /> Registered Y/N Fee Current Y/N
<br /> Address
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<br /> F�II out appiir,ation completety
<br /> Owner&Convacior sign back of applipbon,nofarized{Or,popy of signed contract with owner)
<br /> {f over 52500,a Notice of Cominencement is required(MechaniCal work over$5000)
<br /> SuPP�Y�o(2)sets of drawings with appliCable documentatlon
<br /> Allow 10-14 days for review after submitta!date. Parcel#-obtainetl from Pro Tax Notic;e h //a raiser. as
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