Laserfiche WebLink
813- 780 -0020 City of Z h <br /> ep yrh111S Fire. Fax- 813 - 780 -0021 , <br /> • Permit Application <br /> Date Received I I - Phone Contact for Penrdt <br /> ���� � J... ' ' Owners Phone um <br /> Number Owner's Name RCM I 7 q I lo) 767 <br /> Owners Address - 1 c-e30...? 17 ,.,t 7A ,,t 29944-1,d / - - <br /> Fee Simple Titleholder Name I I Titleholder Phone Number I I 1 1 1 <br /> Fee Simple Titleholder Address I <br /> Job Address Lot # f <br /> Sub Division ( , Parcel # I <br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Terit <br /> I Comm Exhaust Kitchen Hood/Duct I Hazardous Material (Tier 1I or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> I - I Emergency Generator < 30 kw = LP/Natural Gas - Installation <br /> El Emergency Generator > 30 kw I LP/Natural Gas - ANNUAL Sale <br /> Q Fire Protection Maintenance - ANNUAL I Places of Assembly- ANNUAL <br /> Ill f l® •C ia. <br /> Sprinkler ❑ ❑ ❑ 0 n Recreational Bean <br /> Fire Alarm E O I7 17 I I n Sparklers <br /> Hood Cleaning ID p( 0 I ( a Sprinkler System Installations <br /> Hood Suppression 0 ,2 0 I I n Standpipes (Sprinkler Sys) <br /> ri Fire Alarm Installation I Torch Roofing/Tar Kettle <br /> • Fire Pumps I Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL 1 ' Valuation of Project <br /> Fuel Tanks <br /> El Other. I <br /> Contractor Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I License # I <br /> ELECTRICIAN' Company <br /> Signature I Registered Y/ N ` Fee Current I Y/ N I <br /> Address I License # I I <br /> PLUMBER Company I <br /> Signature Registered Y/ N J Fee Current I Y/ N , I <br /> Address ( I License # I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y/ N J <br /> Address I 1 License # I <br /> OTHER Company �i . f i D 6'g j L L I <br /> Signature Ver-501 , L'G Registered Fee Current <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 />