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813 -780 -0020 City of Zephyrhllls Fire Fax- 813-780 -0021
<br /> Permit Application
<br /> Date Received 1 O OR I Phone Contact for Permit 2 Z 7 1 6 3s' are
<br /> Owner's Name 7t� /`() R-7. , 1iN ( fc.,Y Owner's Phone Number (/3 ? y3 ??_1/
<br /> Owner's Address
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address I
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<br /> Job Address Lot #
<br /> Sub Division Parcel #
<br /> I Bio- Hazard Waste Storage — ANNUAL [ I Fumigation Tent
<br /> I Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> Controlled Bum I Hood Installation
<br /> I I Emergency Generator < 30 kw [ I LP /Natural Gas - Installation
<br /> 1 Emergency Generator > 30 kw I I LP /Natural Gas - ANNUAL Sale
<br /> ,jam, Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> IC.ttrlyl !Semi] plUl Vther
<br /> Sprinkler ® ❑ ❑ tf< I Recreational Bum
<br /> Fire Alarm I 1 ❑ ❑ ❑ I I 1 Sparklers
<br /> Hood Cleaning I ❑ ❑ ❑ I I I Sprinkler System Installations
<br /> Hood Suppression E ❑ ❑ ❑ I 7 Standpipes (Sprinkler Sys)
<br /> I - I Fire Alarm Installation I Torch Roofing/Tar Kettle .
<br /> n Fire Pumps I I Waste Tire Storage ANNUAL
<br /> I Fire Works
<br /> I Flammable Application - ANNUAL ( Valuation of Project
<br /> El Fuel Tanks
<br /> [ ] Other: I I
<br /> Contractor Company
<br /> Signature Registered Y/ N J Fee Current I Y / N I
<br /> Address I License # I
<br /> •
<br /> ELECTRICIAN Company I
<br /> Signature Registered Y / N 1 Fee Current I Y / N I
<br /> Address I I License # I l
<br /> PLUMBER Company I
<br /> Signature Registered Y/ N j Fee Current I Y / N I
<br /> Address I License #
<br /> MECHANICAL Company I
<br /> Signature Registered — Y / N I Fee Current I Y / N
<br /> Address I I License # I I
<br /> OTHER Company
<br /> Signature Registered Y/ N I Fee Current I Y/ N J
<br /> Address I I License # 1
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<br /> Directions:
<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 (http: / /appraiser.pascogov.com),
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