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813 -780 -0020 City of ZephyrhiliS'Fire Fax- 813 - 780-0021 . <br /> Permit Application _ <br /> Date Received Phone Contact for Pemrt I 1 I <br /> Owners Name rte, 1 t Owner's Phone Number I 1 10 C)(07 I I /31 <br /> Owner's Address 13 ` a /ir .-- Zr yi-vit ZephytX, A PL - <br /> Fee Simple titleholder Name I I Titleholder Phone Number I I 1 I I <br /> Fee Simple Titleholder Address I <br /> _ _ . �- , _ <br /> f . <br /> '...:..,.__..._.... ....�, _ .......�. .� 7 .. » . ..- a ....�.. -...ems . c. � - . i 8- ..i - ...4 .af.a. ,..- w....2:..�6». <br /> Job Address 1 Lot # I <br /> Sub Division I I Parcel # I <br /> ❑ Bio- Hazard Waste Storage - ANNUAL I Fumigation Tent <br /> r1 Comm Exhaust Kitchen Hood/Duct r---1 Hazardous Material (Tier 1I or RQ Facility) ANNUAL <br /> n Controlled Bum El Hood Installation <br /> ❑ Emergency Generator < 30 kw El Gas - Installation <br /> n Emergency Generator > 30 kw 1 ---- 1 LP/Natural Gas - ANNUAL Sale <br /> ❑ Fire Protection Maintenance - ANNUAL 1 Places of Assembly- ANNUAL <br /> Sprinkler ❑ ❑ ❑ ❑ r1 Recreational Bum <br /> Fire Alarm ❑ ❑ ❑ ❑ 1 1 ED Sparklers <br /> Hood Cleaning ❑ x ❑ 1 1 r Sprinkler System Installations <br /> . Hood Suppression ❑ ❑ ❑ I I r Standpipes (Sprinkler Sys) <br /> r - i Are Alarm Installation ri Torch Roofirgfrar Kettle <br /> ' Fire Pumps 1 I Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application ANNUAL ( I Valuation of Project <br /> Fuel Tanks <br /> 0 other: 1 I <br /> Contractor Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N 1 <br /> Address I I License # I <br /> ELECTRICIAN Company 1 <br /> Signature Registered Y/ N 1 Fee Current I Y/ N I <br /> Address I I License # I I <br /> PLUMBER Company 1 <br /> Signature Registered Y/ N _1 Fee Current I Y/ N j <br /> Address I I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N j Fee Current I YIN I <br /> Address I I License # I <br /> OTHER Company L z. <br /> Signature � wide,. -GC. 4.4._. Registered Fee Current <br /> '� <br /> Address EsS! ,EM !_s License # e ` coo ( r <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 52500. a Notice of Commencement is required (Mechanical work over 55000) <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 />