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813- 780 City of Zephyfiilis - 6/ ,s ` / Fax-813- 780-0021 <br /> Permit Application - <br /> )ate Received Phone Contact for Permit <br /> J <br /> _in`/ l 1 <br /> )wnei's Name : _. Q' I r Owner's Phone Number ' (3 1 1/S ,, O3 ` <br /> )wner's Address S a,' r 4 l rj Fl 335 '] °t` <br /> :ee Simple Titleholder Name 1 Titleholder Phone Number I I i <br /> :ee Simple Titleholder Address 1 1 <br /> ,.,;r i -- F.-.t:' _ .„---5 ,i.'?. -rw. , , , 7 . :..7 . < - •-i t"3..z ' a.,n. '.'; .5-f K. <br /> Job Address 5 a_ , to c- Q. �' A- I Lot # (JO `J <br /> Sub Division Parcel # 1 1 1 A Lo a 1 v O 1 J l co'1 O v Q 1 d 0 <br /> El Bio-Hazard Waste Storage - ANNUAL Fumigation Tent <br /> El Comm Exhaust tGtchen Hood/Duct l I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> 1 1 Controlled Burn n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw L { LP /Natural Gas ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> =ill' 'Semi' &la Other <br /> Sprinkler 1 ` ❑ ❑ ❑ , ( Recreational Burn <br /> Fire Alarm F1 ❑ ❑ ❑ 1 n Sparklers <br /> Hood Cleaning El ❑ ❑ ❑ f 1 n Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ 1 1 1 1 Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation 1 Torch Roofing/Tar Kettle <br /> H Fire Pumps ` 1 Waste Tire Storage ANNUAL <br /> • <br /> Fire Works <br /> El Flammable Application- ANNUAL 1 1 Valuation of Project <br /> 1 1 Fuel Tanks <br /> n Other. 1 <br /> : §+� .:-: 'p' , p ;ti.L.; -9., g-a. rri, ..,.' - .z^ :. ..... -.r: �.�. "..<: _. :. -1M.: j f"±.-�,.- :.. -_•..z �sr_Wp - : .. ..._..._ ..x .,_...�' :e >'�d - " - - 44_,/e-6/4.04,1 <br /> Contractor Company S G /y. // <br /> r c 5 ys , <br /> ..-7 Signat � c Registered T / N j Fee Current Y / N , <br /> Address 1 3 -- 7 `i / f /A . yt J r iL f ? T J License* 1 <br /> ELECTRICIAN Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address 1 1 License # 1 <br /> PLUMBER Company <br /> . Signature Registered Y / N Fee Current Y / N <br /> Address 1 1 License # 1 1 <br /> MECHANICAL Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N 1 <br /> Address 1 1 License # J 1 <br /> OTHER Company <br /> Signature Registered Y/ N j Fee Current 1 Y/ N <br /> Address <br /> � � 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 52500, 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 />