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813- 780-00V City of ZePhyrhilis f ifie- 1 1 t5 Fax -813 -780 -0021 R` <br /> Permit � - _- <br /> - pho CorAaac for Permit <br /> Dat Received _ <br /> 1 `J�- 1 Owners Phone Number mber ] IltI 1 n u � 8 1 <br /> Owners Name \-\6\k°‘ `�c�11�� <br /> Owners Address 1 • 2 \ G o \ Q, \ c 7\4 , cl.•- 1 <br /> Fee Simple Titleholder Name 1 I Titlehoider Pone Number I 1 1 1 1 I <br /> Fee Simple Address 1 I <br /> Sub Division <br /> Me` `Lot # I <br /> Job Address I I <br /> 1 1 Parcel # 1 <br /> n Fumigation Tent <br /> El Bk,_l�rri Waste Storage - ANNUAL <br /> ❑ Comm Exhaust Kitchen Hood/Duct ❑ Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> ❑ Controxed Bum n Hood Installation <br /> ❑ Emergency Generator < 30 kw n LP/Nahra! Gas - Installation <br /> ED er <br /> Emergency Generator > 30 kw ED LP/Natrrat Gas - ANNUAL Sale <br /> ❑ Fire Protection A - ANNUAL n Places of DUAL <br /> ® ®® <br /> sprinkler ❑ 0 0 0 _ ❑ Burn <br /> Are Alarm -00 0 0 1 I EJ Spenders <br /> Hood Clearing 0 0 1 CD SPrndder System Installations <br /> Mood Suppression [J 7 0 0 I ( n Standpipes (swim Sys) <br /> ❑ Fire Alarm Motion ❑ Torch Roofing/Tar Kettle <br /> H Are Pumps ❑ Waste The Storage ANNUAL <br /> Fire Works ' Valuation of Project <br /> Rarrvrrable Application- ANNUAL I <br /> Fuel Tanks 1.7 I <br /> 1 <br /> Si gns car ` - ` ': tlf. , , � I Registered I Y / N I Fee Current I Y / N I <br /> S <br /> Address �� , _ � — Vy - i <br /> ELECTRICIAN I Registered L Y/ N Fee Current Y/ N <br /> Address Signature I 1 License # I I <br /> PLUMBER l I <br /> Signature Y/ N current u reed Y/ N <br /> I I <br /> I I License # <br /> I <br /> Address 1 Company <br /> MECHANICAL I Registered Y/ N 1 Fee Current I Y/ N <br /> Signature I <br /> Address I I License # I I <br /> OTHER I Registered I Y/ N I Fee Current I Y/ N ( <br /> Signature I <br /> license # <br /> Address <br /> Directions: <br /> O awner rt & Contractor r sign back of application. notarized (Or, copy of signed contract with owner) <br /> O & CwMrar sign b <br /> If over $2500. a Notice of Con mencemant is required .(Mechanical work over $5000) <br /> Supply two (2) sets of drawings with applicable documerdaiion Parcel # - obtained from Property Tax Notice (tAtP! /aP er• gc`� ') <br /> Allow 10-14 days for review after submittal date. <br /> I <br /> 1 <br />