Laserfiche WebLink
813-780-0020 City of Zephyrhilis Fire <br /> Fax- 813 - 780-0021 , <br /> Permit Application _ <br /> Date Received 1 I - Phone Contact <br /> for Permit <br /> Owners Name `.. _ Ai L di Owners Phone Number latin 1 779 112Z7Z., I <br /> Owner's Address ' yS / "'� �e T i � D <br /> Fee Simple Titleholder Name I I Titleholder Phone Number I 1 I <br /> Fee Simple Titleholder Address I i <br /> ry <br /> Job Address 17'ycT � j t I Lot # I • <br /> Sub Division I I Parcel # I <br /> 0 Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier 1I or RQ Facility) ANNUAL <br /> El Controlled Bum n Hood installation <br /> a Emergency Generator < 30 kw n LP/Natural Gas - Installation <br /> CI Emergency Generator > 30 kw n LP/Nahaal Gas- ANNUAL Saie <br /> 0 <br /> Are Protection Maintenance - ANNUAL r Places of Assembly- ANNUAL <br /> ® � ® cxtrer <br /> Sprinlder Li ❑ ❑ ❑ I n Recreational Bum <br /> Rre Alarm n ❑ ❑ ❑ 1 I n Sparklers <br /> Hood Cleaning ❑ gft ❑ I n Spnnlder System Installations <br /> V Hood Suppression ED ❑ Col' ❑ ( I n Standpipes (Sprinkler Sys) <br /> • 0 Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> ' Fire Pumps I—I Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL ( 1 Valuation of Project <br /> Fuel Tanks <br /> Q Other: I <br /> Contractor Co I <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I License # I <br /> ELECTRICIAN Company <br /> I <br /> Signature I Registered Y/ N I Fee Current I Y/ N I <br /> Address I ( License # I <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y/N I <br /> Address I I License # <br /> OTHER Company t�i „ • - L E I <br /> Signature e dare. fits- Registered Fee Current <br /> Address ra11M /_s License # ■ e - -Z!@o0 <br /> Directions:, �t <br /> Fill out application completely. <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> If over 52500, 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 (htlpJ /appraiser.pascogov.com) <br />