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813-780-4420 City of Zephyrhilis Fire Fax-813-780-002't
<br /> Permit Application
<br /> Date i2eceived �— �� Phone Gantact for Permit �
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<br /> Owners Name ��' '�( t,5' t�wners Phone Number �__� [� ��
<br /> 4wner's Address [ '
<br /> Fee Simple Titleholder Nama Titleholder Phone Number [� � ��
<br /> Fee Simple Titleholder Address �
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<br /> Jab Addfess s lat# ��
<br /> Sub Division Parcet# �
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<br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent
<br /> � Camm Exhaust Kitchen HoodtDuct � Nazardous Material(Tier II or RQ Facility}ANNUIU.
<br /> � Controlled Bum � � Haod Installation
<br /> a � Emergency Generator<3d kw � LPJNaturat Gas-Instatiation
<br /> � Emergency Generatar>30 kw � LP/Natural Gas-ANNUAL Sale
<br /> � Fire Protectlon Maintenance-ANFlUAL . Places af Assembly-ANTiUAI �
<br /> � emi �n er �,
<br /> Sprinkfer � � O II � Etecreational Bum �
<br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers �p��
<br /> � Ca
<br /> Hood CleanEng � ❑ ❑ ❑ �� � Sprinkfer Sysfem tnstaliations �
<br /> Hood Suppression � ❑ ❑ ❑ C7 � StgndpipeS(Spnnkler Sys)
<br /> � Fire Aiarm Instal(ation Q Toroh Roofing/Tar Kettle
<br /> � Fire Pumps • o Waste Tire Storage ANNUAL
<br /> � Fiammabie Application-AFtNUAL �^—�� Valuation of Praject
<br /> � Fuel Tanks ����������•—
<br /> Q C}ther.
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<br /> Contractor } n �j� Company � �
<br /> Signature �L�����<<--�' �✓ Registered Y/N Fee Current Y/N
<br /> Adt3ress �icense# ,
<br /> ELECTRICIAN Company
<br /> Signature Registered Y I R3 Fee.Current Y 1�V
<br /> Address License#
<br /> P�UMBER Company
<br /> Signature Registered Y/N Fee Current Y/N.
<br /> Address License#
<br /> MECHANICAL Company
<br /> Signature Registered Y 1 R! Fee Current Y 1 tV
<br /> Address License#
<br /> � CITHER Company
<br /> 5ignature Regis2ered Y!N �ee Curtent Y/N
<br /> �� Address License#
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<br /> Directions: ^s..- _. . ,:x:��. ::�::��.;-��.::..:.:._�_.. .�t,�>-�::�:...:,
<br /> FiI!out application comple2eiy.
<br /> Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner)
<br /> K over$2540,a Notice of Comrner�cement is required(Mechanicai work over$5000)
<br /> Supply two(2)sets af drawings v�nth applicabie documentation
<br /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Properry Tax Notice(http:!/appraiser.pascogov.com)
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