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813-780 -0020 City of Zephyrhilis Fire Fax- 813-780 -0021 <br /> Permit Application <br /> Date Received II ! 11 /0? 1 Phone Contact for Permit <br /> Owner's Name //� r/ LL-t T L j- CtA -.� 5 S�k. <br /> ��0VsL Owner's Phone Number <br /> Owner's Address Wf "Web rri S / +T /Q' <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address 1 <br /> a •; °it .-;.m, ! . , °.. ,- . , it d .' _. £ „ .. ; =s, ,. A Y'i m.d. Y irdr M.. x s, :..x _ ., <br /> Job Address 6 ( {S fli5. 1T c r-.4- -710—) �.,� . <br /> Lot # <br /> Sub Division Parcel # <br /> , . . a ... :: m:z' , w, .. ,.,..:T ,Itw,. ,a .<. Tom. , ......,ma ., ,.� .i .i. ., . ate_. , <br /> Bio- Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation _ <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale <br /> I Fire Protection Maintenance - ANNUAL 1 I Places of Assembly- ANNUAL / lutriyi !SemiI WA Other <br /> Sprinkler 12 ❑ n Recreational Bum <br /> Fire Alarm ❑ ❑ •( I I I I Sparklers <br /> Hood Cleaning ❑ ❑ ❑ I I I Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> ; Flammable Application- ANNUAL I I Valuation of Project <br /> 1 —, � Fuel Tanks <br /> n Other: I <br /> Contractor \ Company CO 1/LC n e.corEL�-to•J <br /> Signature / ( c ��t r Registered g stered 0/ N I Fee Current I Y / N I <br /> Address (k) &IL 157 NcrtOSv¢5 SSG S /I $' y I License# I Ef2o60D (, 3 I <br /> ELECTRICIAN Company <br /> Signature Registered Y / N I Fee Current 1 Y / N, <br /> Address 1 I License # <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y / N 1 <br /> Address I 1 <br /> License # <br /> MECHANICAL Company I <br /> Signature Registered Y / N J Fee Current I Y / N j <br /> Address I <br /> 1 License # I <br /> OTHER Company <br /> Signature Registered Y/ N j Fee Current 1 Y/ N I <br /> Address I License # <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 />