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813-780-0020 City of Zepnyrnills Fire Fax-813a8U-UU21 <br /> Permit Application <br /> Date Received J — Phone Contact for Permit YY, s®M 6&16 1 <br /> Owner's Name �GJ�I �J�(/ /�/Z Owner's Phone Number (J <br /> Owner's Address 7 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address Lot# <br /> Sub Division Parcel# <br /> Bio-Hazard Waste Storage-ANNUAL Fumigation Tent <br /> Comm Exhaust Kitchen Hood/Duct Hazardous Material(Tier II or RO Facility)ANNUAL <br /> Controlled Bum =zKood Installation <br /> 0 Emergency Generator<30 kw F7_1 LP/Natural Gas-Installation <br /> Emergency Generator>30 kw F-1 LP/Natural Gas-ANNUAL Sale <br /> Fire Protection Maintenance-ANNUAL = Places of Assembly-ANNUAL <br /> ®y emi ®nFffg <br /> Sprinkler + ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm ❑ ❑ ❑ Sparklers <br /> Hood Cleaning ❑ ❑ ❑ ❑ Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ ❑ Standpipes(Sprinkler Sys) <br /> Fire Alarm Installation Torch Roofing/Tar Kettle <br /> Fire Pumps Waste Tire Storage ANNUAL <br /> j Flammable Application-ANNUAL j0 Valuation.of Project <br /> Fuel Tanks <br /> Q Other: <br /> Contractor ' Company <br /> Signature Registered. Y/N Fee Current Y/N <br /> Address License# <br /> ELECTRICIAN Company <br /> Signature aQ Registered Y/N Fee Current Y/N <br /> Address License# <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> MECHANICAL Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> OTHER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> Directions:. <br /> Fill out application completely. <br /> Owner&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 /> j Allow,10-14 days for review,after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pds6ogov:co*m). <br />