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81�-780-OG20 Ciry of�ephyrhills Fire FaX-a�aaac-oo2i
<br /> Permit Application
<br /> Daie R=ceived. �� � Phone Contact for Fertnit �] � ��� ��
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<br /> Owner's Name ���/lf� �t��,5 j ���/� 5 L�� Owner's Phone Number � � �
<br /> Owner'sAddress ��� � ` � 1 �(� �L� z � ..�� �_� � JC � _ � �
<br /> Fee Simole Titieholder Name Titleholder Phone Number �� � �
<br /> ree Simple i itienolder Address
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<br /> Job Address 3'14 I �.V v� Z�P+�Y � - L 335� Lot� "��
<br /> Sub Division Parcef� b3�a�' �� —(j 01 D• Uvr' �b b- DO C'O
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<br /> � Bio-Hazard Waste Sioreoe-ANNUAL � Fumiaation Tent
<br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL
<br /> � Controlled Bum � Hood Installation
<br /> � tmergency Generetor<30 kw � LP/Naturai Gas-Installafion
<br /> � Emergency Generetor>30 kw � LP/Natural Gas-ANNUAL Sale
<br /> -.� Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL
<br /> tny emi Hni ner
<br /> Sprinkler � p G ,� B � Recreauonal Bum
<br /> Fire Alarm � O ❑ ❑ � � Sparklers
<br /> Hood Cieaning � C, ❑ ❑ � � Sprinkier System Ins.ailations
<br /> Hood Suppression � ❑ ❑ ❑ � a Standpipes(Sprinkler Sys)
<br /> � Fire Alartn fnstallation � Torch RoofinglTar Kettle
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> � Fire Works
<br /> Flammable Application-ANNUAL
<br /> Valuation of Project
<br /> � Fuei Tanks
<br /> � Other
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<br /> Contrector
<br /> Company
<br /> Signature Registered Y/N ree Current Y/N
<br /> Address License#
<br /> ELECTRICIAN Company
<br /> Sigra�ure Registered Y/N Fee Current Y/N
<br /> Address
<br /> License�
<br /> PLUMBER Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Addr=ss
<br /> License#
<br /> McCHANICAL Company
<br /> Signature Registered Y/N ree Current Y/N
<br /> Address
<br /> License#
<br /> OTH�P, Company Z L� �Z,eG' D 7"!�'C 7"rcw�
<br /> Signature Registered /N ree Current Y/N
<br /> Address - .
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<br /> / License�
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<br /> Directions: ,.. _._ _ .�,,.._....�.__ :+ _. _ ._._ _._�..__....._..��... .. .. .._._,_...__,_- . . ....... :...
<br /> Fill out appiication completely
<br /> Owner&Contractor sign back of application,notarized(Or,copy of signed contrect with owner)
<br /> I�ove;�250G,a Notic=o;Commencemen;is required(Mechanical work over W5000)
<br /> Suppiy iwo(2)s=ts of drewings with applicabl=documenta[ion
<br /> Alio��1 C-14 days for roview after submittal date. Parcel�-obtained from Proper,y Tax,Notioe(http://appraiser.p2soogo�.com)
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