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813-780-0020 City of ZephyrhillS Fire V` 'Eax7813-780-0021 <br /> Permit Application Ix <br /> Date Received Phone Contact for Permit <br /> Owner's Name e. Owner's Phone Number <br /> Owner's Address Fii.�oZ S Cs/Lrb C. L£ C,WA PC,L L -3� ,�{=. .7•�. �+ ; <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> . � <br /> Fee Simple Titleholder Address <br /> Job Address Lot <br /> Sub Division Parcel# <br /> 1gJ t17LYC��ecwvi�icin�g�girarmxmi VilzlCrr) <br /> 0 Bio-Hazard Waste Storage-ANNUAL Fumigation Tent <br /> 0 Comm Exhaust Kitchen Hood/Duct Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> 0 Controlled Bum Hood Installation <br /> 0 Emergency Generator<30 kw LP/ atu ' Gas-Installatior <br /> 71 Emergency Generator>30 kw LP/Natural Gas-ANNUAL Sale <br /> 0 Fire Protection Maintenance-ANNUAL Places of Assembly-ANNUAL <br /> m rNe-m—il AN Other <br /> Sprinkler ❑ ❑ ❑ El 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 /> HFlammable Application-ANNUAL Valuation of Project <br /> Fuel Tanks o <br /> 0 Other: ll)I1 '' <br /> Contractor Company <br /> Signature Registered Y/N Fee Current <br /> Address License# <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address r' tJ G L S License# c, D S 7 /b �-- <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 /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com) <br />