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� s�3-�sa-oo2o City of Zephyrhiils Fire �� `-�t'�" � � �ax-813-780-0021 <br /> ��� ���� �? Permit Application <br /> Date Received � Z �'� _ __ phone Contact for Permit �` - -1� p� Z <br /> r----_.,.._.___.—�— C,K.P <br /> I 4wnar's Name Ruby TUt'.SC1ay Itic �T�� ' � t�� � �..�� �,��� <br /> Qwner's Phone Number (yp <br /> C}wner's Address 333 East Sroadway <br /> Fee Simple Titleholder Name � L� I <br /> Titleholder Phone Number <br /> Fee Simple Tifleholder Address � I <br /> � � -- - --- — <br /> —��. <br /> ---------- ---_ _ ---�— -- <br /> -- - --- - __:_ :- _ ---:_—�-- -- -~-- - - - - "-_______v_'.`�,._'7 <br /> Job Address 1"1 t�.�� ��C i� 1/�J V � �'� � r h t t 1 s �L. 3 3 ��2 Lot# �� <br /> Sub Divisian Pa«��# -25 2�-c�a�c3-.ao�ao� az <br /> � Bia-Hazard Waste Storage-ANNUAL � a Fumigetian Tent J v <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> ' � Controlled Burn � Hood Installation I <br /> QEmergency Generator<3Q kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw L.PlNatural Gas-ANNUAI Sale � <br /> _ _ _ _�__ _Fire Protecfion Maintenance-ANNUAL _ _ �Piaces ofAssembiy-ANNUAL �� , �_� ` <br /> tr y emi � t er � , �I <br /> Sprinkler � p O O � � Recreational Sum � <br /> Fire Alarm � ❑ ❑ ❑ � � gparklers <br /> ' Hood Cteaning � ❑ D CJ � � Sprinkler System instaliations �'" ���� <br /> Hood Su ression ❑ ❑ p �l �� <br /> pp � � � Standpipes{Sprinkler Sys) <br /> QFire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Flammable Application-ANNUAL �—�—� Va(uation of Prpject <br /> Fue!Tanks <br /> Q O#her: <br /> �--- - <br /> i Contractor � _—'� Com an <br /> P Y <br /> Signature � � Registered Y/N Fee Current Y/N <br /> Address �icense# <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Current Y/�1 <br /> Address �icense# i <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Current Y/N � <br /> Address License# I <br /> iMECFfANiCAL Company <br /> Signature Registered Y/N Fee Current Y/N <br />� Address Licenss# <br /> OTHER /� Company <br /> Signawre (�' tl���j j(� �(/�• � ,�r�' Registeted Y/(�I Fee Currenf Y 1 N <br /> Address � ��,� �/ �j D License# <br /> C,__._______A �� _ <br /> ..�..Y _--�—_� <br /> Directions: <br /> Fill out application completely <br /> Owner&Cantractor sign back of application,notarized(Or,copy of signed contract with owner) <br /> If over$2500,a Notice of Cammencement is required{tu{echanical work over$5d00} <br /> Supply two(2)sets of drawings with applicable documentation <br /> Allow 10-9 4 days for review after submittal dafe. Parce!#-abtained from Property Tax Notice(http:(lappraiser.pascogov.com) <br />� <br />