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813 -780 -0020 City of Zephyr ills Fire. Fax- 813 -780 -0021 <br /> Permit Application - - <br /> Phone Contact for Permit 1 5V 1 .5 we 1 <br /> )ate Received > a,. =.,.w �.• �M,... ..: :. <br /> )wner's Name 1;114 t r'1.j tJU - R 1 \ LL l - l Owner's Phone Number <br /> >wner'sAddress 1 9a 5 Con ch v h a , k,e. , A. 30. AcA_ C4 newir( "Po. 1 cma c /d. /o4-- <br /> =ee Simple Titleholder Name Titleholder Phone Number 1 I <br /> =ee Simple Titleholder Address <br /> �,�_�,. s ,�nnartwsee enreua _, � .:_a,.:;t+i -< +xr,P „s .e:.: - .;: �+ : <•..i ,..�. . - -:_ ..L.;a�s... .. - , -t.�. a s -,. �.. <br /> Job Address <br /> - Qr• L. . i ► �� Lot# <br /> Parcel # -' o- /C - WSW() - 000 <br /> Sub Division __ <br /> r I r ' . as troi ua'R::+ 1w ...,z `L`�r`�3viw, t;'..,' `'s4s"'ru"..•r .,: <br /> fib c �a�� .. . "T" ..:� -.- .;.r , r' .N -. ... , <br /> 1- Bb- Hazard Waste Storage ANNUAL El Fumigation Tent <br /> Comm Exhaust Kitchen Hood/Duct 1 1 Hazardous Material (Tier II or RC Facility) ANNUAL <br /> 1 - 1 Controlled Bum 1 Hood Installation <br /> 1 — I Emergency Generator < 30 kw 1i LP /Natural Gas - Installation <br /> E Emergency Generator> 30 kw 1 LP /Natural Gas - ANNUAL Sale "!' 9172 <br /> r Flre Protection Maintenance - ANNUAL Places of Assembly- ANNUAL <br /> i api (semi) Fri Utner <br /> Sprinkler 0 ❑ ❑ ❑ 0 I I Recreational Bum <br /> Fire Alarm s -- - -_❑ ❑ ii 1 1 n Sparklers <br /> Hood Cleaning ❑ ❑ ❑ 1 1 1 1 Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ 1 I 1 I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation 1l Torch Roofing/Tar Kettle <br /> R Fire Pumps 1 I Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL H <br /> Fuel Tanks ! I Valuation of Project <br /> 1 Fuel Tanks <br /> n Other: 1 <br /> Contractor Company 4. • lc 5 al <br /> Signature <br /> IL--- <br /> „ 29( D Registered MEM F Curreennt Y / N <br /> Address . "3 7 bt t 4, c2 l7a -LA- 1 License# of OCZ / 70 1 <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address 1 — 1 License # 1 <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current 1 Y/ N I <br /> Address 1 1 License # 1 1 <br /> MECHANICAL Company <br /> Signature Registered Y/ N 1 Fee Current 1 Y / N I <br /> Address 1 1 License # 1 1 <br /> OTHER Company <br /> Signature Registered 0 Y/ N I Fee Current 1 Y / N 1 <br /> Address 1 ( License # I1 <br /> ,wm <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_ /lappraiser.pascogov.com) <br />