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813- 780-0020 City of Zephyrhilts <br /> Fax - 813 -780 -0021 <br /> Permit Application _ <br /> late Received • one <br /> Phone Contact for Permit I <br /> )wners Name ''' _ . - c: Owner's Phone Number 20/3 GI 9_6 y 5 0 <br /> )wner's Address 6 3 5 3 s4 gat z Flit ir l,", .) f( 33 s i - <br /> 'ee Simple Titleholder Name , Titleholder Phone Number i <br /> :ea Simple Titleholder Address <br /> Job Address 53 S 5 ` . Lot# <br /> Sub Division -1: ■ ' c & Z e. VV, `, \` S Parcel # 1 1 t ' D.� • al -11(»D-011,/094 <br /> .`.._ .....,., -ra -,., ,,-, . , , -.. ,»rsa; .1 t,,,..-...,,,-- ,- -x. ° d4" , = , %" ,,, .^ ._; . 5; s».'=1 0 ,7wry0 „ .....4 ,- w«.....N.�.. , _ - _.... ..s• 4 i ,.” :. <br /> n Bio- Hazard Waste Storage - ANNU . a Fumigation Tent <br /> ED Comm Exhaust Kitchen Hood/Duct I I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> ( I Controlled Bum El Hood Installation <br /> r -- , Emergency Generator < 30 kw n LP /Natural Gas - Installation • - <br /> [ t Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL n Places of Assembly-ANNUAL ,�/ <br /> Lai© isemil Other /¢ <br /> Sprinkler n ❑ ❑ b n Recreational Bum <br /> Fire Alarm E ❑ ❑ A, I i n Sparklers <br /> Hood Cleaning El ❑ ❑ ❑ I I ED Sprinkler System installations <br /> Hood Suppression ❑ ❑ ❑ I I { I Standpipes (Sprinkler Sys) <br /> 1 Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> R n Fire Pumps <br /> Waste Tire Storage ANNUAL <br /> • Fire Works <br /> [-{ Flammable Application- ANNUAL ! 1 Valuation of Project <br /> ' I Fuel Tanks <br /> n Other I <br /> Contractor " ,_ Company 7/ ci i /A/ /�/r/4ti, - <br /> G r, Sy 674""^5 <br /> Signature J / Registered Y / N I Fee Current ( Y / N I < <br /> Address Y7 /7 - z ,4 Z-- I License* ,Ei 00 /0 % <br /> ELECTRICIAN Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address I License # <br /> PLUMBER Company <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I I License # I I <br /> MECHANICAL Company <br /> Signature Registered . Y / N I Fee Current I Y / N <br /> Address I I License # I <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I <br /> License # <br /> T; _-= <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 />