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813 -780 -0020 City of.Zephyrhllls Fire. r "` -o i ° - ' °" -""`' <br /> Permit Application -• . <br /> Date Rece'w;:. - Phone Contact for Permit & t 3 , Z( t -59 <br /> - <br /> Owner's Name I O l —l) t 1 S 1 Owner's Phone Number 1 11 I I <br /> Owner's Address 1 1 8 3 3 c=I-c x__ (LPL <br /> Fee Simple Titleholder Name Titleholder Phone Number I I , <br /> Fee Simple Titleholder Address <br /> Job Address I 85 3 (,hu 6(-A t7 Lot# <br /> Sub Division L TY b r ZE PM Y 1 44. 1(Ls Parcel # <br /> EI Bio- Hazard Waste Storage - ANNUAL I-1 Fumigation Tent <br /> a Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> El Controlled Bum h Hood Installation <br /> Emergency Generator < 30 kw I-1 LP /Natural Gas - Installation <br /> E Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> IINI Fire Protection Maintenance - ANNUAL Q Places of Assembly- ANNUAL <br /> mi7(7 emi MI LRher <br /> Sprinkler 2 ❑ ❑ Recreational Bum <br /> Fire Alarm 0 ❑ ❑ ❑ I 1 = Sparklers <br /> Hood Cleaning 0 ❑ ❑ ❑ . I ( a Sprinkler System Installations <br /> Hood Suppression 0 ❑ ❑ ❑ I ( a Standpipes (Sprinkler Sys) <br /> El Fire Alarm Installation I Torch Roofing/Tar Kettle <br /> Fire Pumps I Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL I 1 4 7,-,.< DO I Valuation of Project <br /> Fuel Tanks <br /> 0 Other: I I <br /> Contractor - '"C'. - �• •any Comte. F -1.2 SPR.t &We.% MC <br /> Signature rig. Registered ( N I Fee Current / N <br /> Address I Zzt7 l 1.4 • /V I . 'i1 -, F . 3 5(.6 I License # k(o 6'1 S Loon it 4 1 4 17 I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current 1 Y/ N I <br /> Address I j 'V" ,,,,, I License # <br /> PLUMBER Company % <br /> Signature i Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # I I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I I License # I <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <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 (httpJ /appraiser.pascogov.com) <br /> • <br />