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<br />813-780-0020 <br /> <br />Date Received <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />:f:f1r!>f 5 <br /> <br />City of Zephyrhifls Fife, <br />Permit Application <br /> <br /> <br />Fee Simple Titleholder Name <br />Fee Simple Titleholder Address <br /> <br />Fax-813-780-0021 <br /> <br />Phone Contact for Permit <br /> <br /> <br />~ / i I h y).. II '1'"4/"7 I <br /> <br />r2 V <br />Titleholder Phone Number I II II <br /> <br />Job Address <br /> <br />I Lot# <br /> <br />Sub Division <br /> <br />o <br /> <br />~ <br /> <br />o <br /> <br />o <br />o <br />o <br />o <br />o <br />o <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br />Comm Exhaust Kitchen Hood/Duct <br />Controlled Bum <br /> <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />~~ ,~~m"~D <br />Dooor==J <br />Dooor==J <br />Dooor==J <br /> <br />Parcel # <br /> <br />D Fumigation Tent <br />D Hazardous Material (Tier /I or RQ Facility) ANNUAL <br />D Hood Installation <br />D LP/Natural Gas-Installation <br />D LP/Natural Gas-ANNUAL Sale <br />D Places of Assembly-ANNUAL <br /> <br />D Recreational Bum <br />o Sparklers <br />o Sprinkler System Installations <br />o Standpipes (Sprinkler Sys) <br />D Torch RoofingfTar Kettle <br />o Waste Tire Storage ANNUAL <br /> <br />Valuation of Project <br /> <br /> <br />Sprinkler <br /> <br />Fire Alarm <br /> <br />Hood Cleaning <br /> <br />Hood Suppression <br /> <br />Fire Alarm Installation <br /> <br />Fire Pumps <br /> <br />Fire Works <br /> <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />Other: <br /> <br />?~/O <br /> <br />OTHER <br />Signature <br />Address <br />Directions: <br /> <br /> Company <br /> 1;:;' R ~J'n}i Registered <br />/I. License # <br /> Company <br /> Registered <br /> I License # <br /> I Company <br /> Registered <br /> , License # <br /> I Company <br /> Registered <br /> I License # <br /> I Company <br /> Registered <br /> License # <br /> <br />Contractor <br /> <br />Signature <br /> <br />Address j <br />ELECTRICIAN <br />Signature . <br /> <br />Address I <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANICALl <br />Signature , <br /> <br />Address I <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Y/N I <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <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 (hltp:llappraiser.pascogov.com) <br />