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81 90 -0020 City of 2ephyrhills Firje
<br /> ' ,�✓ � 61 ( Fax - 813 -780 -0021
<br /> Permit Application �' ,
<br /> Date Received _�. I - Phone Contact r
<br /> for Permit j1
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<br /> Owners Name 1 � j \\VCA C40 yG Owner`s Phone Number 121M1 J`1u 1 [vti
<br /> Owners Address 1 3 (o% M CNw6 ‘Auu ye._ t r 7 ; \AQ\i 1/4&5 ` —'
<br /> Fee Simple Titleholder Name 1 Titleholder Phone Number ( 1
<br /> Fee Simple Titleholder Address I
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<br /> Job Address Lot #
<br /> Sub Division I 1 Parcel # (
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<br /> fl Bio- Hazard Waste Storage - ANNUAL . . r Fumigation Tent
<br /> I Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> 7 Controlled Bum Hood Installation
<br /> El Emergency Generator < 30 kw I LP/Natural Gas- Installation
<br /> Ei Emergency Generator > 30 kw I ( LP/Natural Gas - ANNUAL Sale
<br /> pi Fire Protection Maintenance - ANNUAL 1 1 Places of Assembly- ANNUAL
<br /> ®®® Utner
<br /> Sprinkler I—I ❑ ❑ ❑ r Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I 1 I Sparklers
<br /> Ho od Cleaning ❑ �L ❑ I ) I Sprinkler System Installations
<br /> Hood Suppression ❑ /❑ ❑ I I r] Standpipes (Sprinkler Sys)
<br /> ED Fi Alarm Installation I I Torch Roofing/Tar Kettle
<br /> Fire Pumps I-I Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> Flammable Application- ANNUAL I ' Valuation of Project
<br /> Fuel Tanks
<br /> • •i er. I
<br /> Contractor ) Company
<br /> Signature _ tiy‘( ' • " , V[ Registered Y / N I Fee Current I Y / N
<br /> Address . _- h - �7c' ' - i +
<br /> -) 3 License # I I
<br /> ELECTRICIAN Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N
<br /> Address I I License # I I
<br /> PLUMBER Company I
<br /> Signature Registered Y/ N 1 Fee Current I Y/N I
<br /> Address I I License # I
<br /> MECHANICAL Company I
<br /> Signature Registered Y/ N j Fee Current 1 Y/ N I
<br /> Address I I License # I I
<br /> OTHER Company I
<br /> Signature Registered Y/ N] Fee Current I Y/ N I
<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 frorn Property Tax Notice (httpi /appraiser.pascogov.com)
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