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ti <br /> 813-760-0020 City of Zephyrhffls Fire Fax-813-780-0021 <br /> Permit Application , <br /> Date Received _ ) Phone Contact for Permit <br /> Owner's Name _ A" AQ--v 1�;cc ry Owner's Phone Number <br /> Owner's Address t t7 tD n lv. 7'4 t�r"147r 1 <br /> Fee Simple Titleholder Name Titleholder Phone Number i <br /> Fee Simple TitlehotderAddress <br /> Job Address ~�W U-1 C.� 3Lv� � pN`9ButctS l 335Lf1 lat#t <br /> Sub Division Parcel# '�J=ol l—01 L D- Co too (00 l0 <br /> Bio-Hazard Waste Storage-ANNUAL a Fumigation Tent <br /> Comm Exhaust Kitchen HoodtDuct Hazardous Material(Tier if or Rt2 Facft)ANNUAL _1 <br /> Controlled burn � Hood Installation <br /> Emergency Generator a 30 kw L-PINatural Gas-lnstaffattor G <br /> Emergency Generator:,-30 kw LPINatural Gas-ANNUAL Sale yy��,,""� <br /> 0 Fire Protection Maintenance-ANNUAL Places of Assembly-ANNUAL -Z"k U <br /> mi [Xia r <br /> Sprinkler ❑ O ❑ O Recreational Bum <br /> Fire Alarm O Q O Sparklers <br /> Hood Cleaning O ❑ ❑ Sprinkler System Installations <br /> Hood Suppression O ❑ O Standpipes(Sprinkler Sys) _ <br /> ® Fire Alarm Installation,, /�() v/•!,(� Torch Rooffngr r r Kettle <br /> LT_iit Fire Pumps +r t I K Ttre N <br /> RFlammable Application-ANNUAL V luation o Pro <br /> Fuel Tanks <br /> Q Other. , <br /> Contrador V,N S company bLr .�+l' C+�l7 ti� �A9 Ci <br /> signature Registered Y/N Fee current Y I IV <br /> Address License# t Z <br /> ELECTRICIAN Company ft+ature Registered YIN Fee Current -YIN <br /> Address] License# <br /> PLUMBER Company <br /> Signature F Registered Y/N j 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 Eal Fee Current t 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$50001, <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(h*.11appraiser.pascogov.eom) <br />