Laserfiche WebLink
813- 780 -0020 City of ZephyrhiUs Fax - 813-780 -0021 it <br /> Permit Application . _ _ <br /> Date Received Phone Contact for Permit 1 (.a Zl J 135'7 <br /> l <br /> ,� {'FE 'T*w n.: -. a �� .. r , c-...v .., , -,t, W a: _ _ -'. - •-, c - - . r ::r«mn a�*t¢ , <br /> Owners Name t.b1(,leV-) <Fje5 t.-4. I Owners Phone Number ( 1 <br /> • <br /> Owner's Address ( us C...-VNie5L4Ol4OC b lam -5r, gb, <br /> Fee Simple Titleholder Name Titleholder Phone Number , <br /> Fee Simple Titleholder Address I I <br /> Pi <br /> Job Address ' ' O( , (9 PAtr> , u�tt Lot# <br /> Sub Division 1 OP Z C'l0 kt"ig- -thU.s Parcel # ZS • Z,1 to AymW 0006 <br /> El Bio- Hazard Waste Storage - ANNUAL ED Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum n Hood Installation <br /> LJ Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> (7 Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> � <br /> 71301 'semi' raj Uther <br /> Sprinkler E 4 ❑ ❑ n Recreational Bum <br /> Fire Alarm El ❑ ❑ ❑ I 1 n Sparklers <br /> Hood Cleaning 0 ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression Ej ❑ ❑ ❑ I 1 n Standpipes (Sprinkler Sys) <br /> a Fire Alarm Installation = Torch Roofing/Tar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL I 44 .7-..V. 00 ( Valuation of Project <br /> Fuel Tanks <br /> Q Other: I <br /> Aro or maw <br /> Contractor ' - f' R <br /> . bti►) Company AMAIN F12 5Ati 'KL7t l s . / I <br /> Signature r/ - Registered Y / N I Fee Current Y / N <br /> Address I IF License # S a 0L4,),rx711 41 1S CI. <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N 1 Fee Current I Y / N <br /> Address I License # I <br /> { <br /> PLUMBER Company I <br /> Signature *. Registered Y/ N I Fee Current 1 Y / N I <br /> Address I I License # I I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current I Y / N 1 <br /> Address I I License # <br /> OTHER Company I <br /> Signature Registered Y/ N 1 Fee Current I Y/ N 1 <br /> Address 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 />