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s�s-I ao-oo2o City of Zephyrhilis Fire Fax-813-780-0021 �
<br /> I ;Permit Applicat'ion
<br /> Date Received � Phone Contact for Permit ���
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<br /> Owner's Name ���1 A N (5 L U g �'�� ����"r 2'� '�Phone Number � � �
<br /> Owner's Address� � � ���`C V� �' �
<br /> Fee Simple Titleholder Name Titleholder Phone Numbe� � � �
<br /> Fee Simple Title lolder Address �
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<br /> Job Address �`� � Lot# ,I
<br /> Sub Division � Pa�cel# ` ' !
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<br /> �� Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent i
<br /> �I Comm Exhaust Kitchen Hood/Duct � tHaiardous Material(Tier II or RQ Facility)ANNUAL '
<br /> �I Controlled Bum � Hood Installation
<br /> � ; Emergency Generator<30 kw � LP/Natural Gas-Installafion �
<br /> j Emergency Generator>30 kw � CP/Natural Gas=ANNUAL Sale
<br /> �� Fire Protection Maintenance.-ANNUAL . . � Places of Assembly-ANNUAL ���
<br /> � try emi �n t er ,- - n
<br /> Sprinkler - �'` ❑ ❑ �;*;B � Recreational Bum � �
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<br /> Fire Alartn � ❑ ❑ ❑:�� ❑ Sparklers ,
<br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations
<br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(SprinklerSys)
<br /> � I �
<br /> �� Fire Alarm Installation Torch Roofing/Tar Kettle '
<br /> � ''' Waste Tire Stora e i4NNUAL
<br /> �� Fire Pumps � 9
<br /> �� Fire Warks
<br /> �; Flammable Application-AtdNUAL ValUetlO�Of PfOJeCt
<br /> '� Fuel Tanks •
<br /> ; Other: � _. - -
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<br /> Contractor � � ' Company
<br /> Signature Registe�ed Y'/''N ` �Fee CuRenf� Y/N
<br /> Address � � ` " � �L'icense# • - �
<br /> ELECTRICIAN Coinpany -
<br /> Signature 'Registe�etl" �°Y l N Fee'Gurrent` Y/N � • i
<br /> Address � Cicense# � '
<br /> , „ � �,-_
<br /> PLUMBER • ' Company , .�� � . �,`:,
<br /> Signature Registe�ed Y b N, Fee Current Y/N.. '
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<br /> Address ' License# '
<br /> MECHANICAL - Company ' � �
<br /> Signature Registered Y/N Fee Current Y/N ` '
<br /> � - • ,
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<br /> Address License# - , �
<br /> OTHER Company � '
<br /> Signature Registered Y/N Fee Current Y/N ,
<br /> Address License# ' �
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<br /> Direciions: f l^� � � � .. �'�
<br /> Fill out application completely. , �
<br /> Owner 8�Contractor sign back of application,notarized(Or,copy of signed contract with owner)
<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 /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com)
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