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873-780-0020 City of Zephyrhi(!s Fire Fax-813-780-002� <br /> Date Reca:ved - �__' � <br /> ermit Applicatian <br /> =.w:.t, ti�_:_.._-..�- -- - <br /> ��. .�-,._��- <br /> Phone Contact tor Pertnit } 9�1,'� �q <br /> - - w�.:•x-•:- . _ -----_ <br /> . ..._ _ ._.. �:���.,��.-��_a_t�::-=�,-�_�..-�=.::���_-�--- -��:rz..__. '�Z . - <br /> _ q3 <br /> .. ____.... •_:=�:..�:::_.�-::_.:�_;:._- <br /> Owner's Name �,��'/Z,r(,�N{� �� Jn/�/I�DpP�/�,� OwriEr'S PhOaE NurttbK b �3 l b � 71�l,� <br /> Gwner�s Address 3�'a a o fi/�/L y � �Q�C� ��ft�lLLS �3`.� ��- <br /> Fee S�mple Titleholder Name TiqehOfd@f Phpr►e Number � C� � <br /> r,�c,mpie TdteholtlerAtldress <br /> � <br /> :-5,:��"°="_;:;-�:�°� �,�m� - -- <br /> � .,�__.,_�.__.___�r�::�?:_=.�.'.:._..,� <br /> l�bAddre55 .JO ��� Gh�dZy 4J� z—l'f��.�.� �(� �j3� �� LOt# � <br /> 5up Division <br /> P2rCN#� <br /> . _-_�_==�:_-�__-���-�.��..� . .. <br /> - _`�- a€x�..v �_ - - ��--:_--�_.. ._ <br /> � BiaHazard 1Maste Storage-ANNUqL � Fiazardp�g Materi�t(Ter p w RQ Facility)ANNUAL <br /> � Comm Exhaust tGtthen Noodlpuct � ����� <br /> � Conirolled Bum . � �p/ry�p����„��ilation <br /> � Emergency Generatpr<30�, ., � tPMalurai C�83-pNNUA,L Sale <br /> � Emergen�y veneraior>3p kwr � Places ofAssgnlbiy.qNNUAL <br /> � Fire Protectipn Mairrterwnae.ANNUAL Q RgCrc�pr�al Bum <br /> �� �r� ef � <br /> sprinkler a o ❑ spaAcleers <br /> Fire Alarm O D <br /> �� � Spnnlder System Inshallations <br /> Hood Cleaning p p � Q <br /> � ��P�Pes(Sprinkbr SYsj <br /> Hooc Suppresslon p ❑ ❑ Tord1 RooTi <br /> � a9/Ta�Ksttle <br /> Fire Alartn Insta7latipn a yYASte Tir�Stprdge ANNUAI <br /> � Fire Pumps <br /> Fire Wbrlcs <br /> � Flammable Appiica6on-ANNUAI �--�••��. <br /> Puel Tanks <br /> Valuation ot Pro�ect <br /> ❑ Other: <br /> - - -._� -_:;� <br /> �.o��tractor _:�;--:.:-.s:,� <br /> eu.t,e�_=_.__ <br /> ��m2ture ��Y � � 'O � <br /> Re9�rod Y%N Fee Current Y!N <br /> Address 35 31 Ke �� <br /> uce"�e# F O tl 1 <br /> I.:_t,TF1ICIAN <br /> ar.ature C��'�P�1y <br /> A�dress <br /> Re9�sred Y 1 N Fee Current Y I N <br /> ticense# �—� <br /> L;JN�ER <br /> ;,g�a�ure C«�pany °------------- <br /> 4tldress <br /> R��s�tl Y/N Fee Current Y/N <br /> I.IC@pS8# � <br /> N1Ft;hiANiCAL <br /> `��qnature CptnpartY <br /> Address <br /> Registeroa Y./N Fee Currant Y 1 N <br /> � �* � <br /> �THER <br /> Signatur@ �Wi1�Ry <br /> Address �9'�"� Y t N Fee Current Y/N <br /> -�:.--=-_- - t .__- _ _ <br /> hrer,tions ' � - -.�=- -�_ .... 1J(xfldE� <br /> `�-�_�_ - -�.. - -- <br /> ,_ <br /> Fii(out applic�fion cpmpleteiy, -= "�-���'� ---.� -_ - .. <br /> Owner&CAntrac[a�gn badc of 2ppp�,����ta.CoPY pf s+grted ContrdCt with owr�er) , <br /> if over S2500,a Notice ot Commeno�n�����������000) <br /> SuDP�Y nvo(2)Sets of drawwu�s with�,1pNqplt d0amentaUpn <br /> Atlow 10-14 deys f0!t9Yiew 3R�SUbrt1�d3fB. P8�Ce1#-ObtainEtl frOfMl PfOp2f�/T87(NOLCE h // <br /> � �P� aPP�iSEf.pdSCpQOV.(p7n) <br />