Laserfiche WebLink
� s�s-ieo;,0020 -;_� City of Zephyrhilis Fire � �JD ( �� Fax-813-780-0021 <br /> � Permit Application <br /> Date Received Z� �� Phone Contact for Permit�� 3 � _ ��(� <br /> r_-- ---- -- ---- - -- -- -- — <br /> Owner's Name � �-�.`e�JC�.Ct ,�--(�C Owner's Phone Number �� ��� S1Db <br /> Owner's Address� � _J� (�t7. `�k�C�'1 !�w'� ` '� `�r V l���C � 31�a� <br /> I Fee Simple Titleholder Name Titleholder Phone Number � � � <br />' Fee Simple Titleholder Address <br /> C,-0- - - - ------ �-----�- -- —�- -- -- ------- - ------- --- ----=----- -__�- ------�-- -- ------�---- -•- - <br /> Job Address , � ��� G�i ,� �1 J W 'e h f � 1 ��S ��+ ��Sy2 Lot# � <br /> � <br /> Sub Division Parcel# <br /> �-----�--g----- ___ _ <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent � <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL /�� <br /> � � <br /> � � Controlled Burn � Hood Installation � � <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br />__ ____ � Fire Protection Maintenance-ANNUAL _ _ _ �Places of Assembly-ANNUAL_ _ _ _ <br /> � tr y emi �n t er < ' <br /> , Sprinkler � ❑ ❑ ❑ B � Recreational Burn <br /> I� Fire Alarm ❑ ❑ ❑ S arklers �/ <br /> , � � � P <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <br /> II Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) I <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle , <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Flammable Application-ANNUAL V81U8t1011 Of PfOJ2Ct I <br /> � , <br /> � Fuel Tanks <br /> !, Other: <br /> � _______gT <br /> Contractor � � Company <br /> Signature G Registered Y/N Fee Current Y/N <br /> Address ��� (� ��C h �t �Lfw! �1«'C -T�-�1 1�►License# <br /> ELECTRICIAN . Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address �� ' License# <br /> PLUMBER { Company <br /> Signature I Registered Y/N Fee Current Y/N <br /> Address �j - License# <br /> MECHANICAL I Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address �j License# <br /> OTHER I Company <br /> Signature Registered Y/N Fee Current Y/N , <br /> Address �� License# � <br /> r----- _ _ f —_ _. ---� <br /> Directions: � , <br /> Fill out application completely. I <br /> Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner) i <br /> If over$2500,a Notice of Commencement is required(Mechanical work over$5000) <br /> Supply two(2)sets of drawings with applicable documentation <br /> iIlow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com) <br /> I <br /> � <br />