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813-780 -0020 City of . Zephyrhilts Fax- 813-780 -0021 <br /> Permit Application <br /> Date Received I Phone Contact for Permit �� w <br /> Owner's Name NOVA £2 e 4. /J4'C S& I4'c r )4/C . Owner's Phone Number . <br /> Owner's Address A 0 ,Asox, '/9GG /12,04 33C77 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> t.s.., t^� C J ^ . k ,, _ v x? <br /> Job Address 1 v )i `�LP C a <br /> r 4a' �0-�1-1,19' Lot# <br /> Sub Division <br /> Parcel S6`*L. *4.,X oY'k.r .4 'Ys'_> ,.r *.•. -. c .< .:. .v _ x .. s$Jvi.�_. _ .5t,$4t•n?F'+ c. _ <br /> F - 7 Bio- Hazard Waste Storage — ANNUAL n Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct I I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I I Controlled Bum I Hood Installation <br /> I I Emergency Generator < 30 kw . I LP /Natural Gas - Installation • <br /> I Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale - <br /> --. _ ■"I I Fire Protection Maintenance - ANNUAL i I Places of Assembly-ANNUAL ///��� L A <br /> i <br /> C��"clJt Icttrlyl IsemiI Uther ( / <br /> Sprinkler n ❑ ❑ ID Recreational Bum �{/ / <br /> L- 4 1 6......... ; € <br /> Fire Alarm n ❑ ❑ ❑ I . ( I I Sparklers ' <br /> �ONeO/J DEC.Z2. Hood Cleaning 1 � ❑ ❑ I 1 1 I Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I I I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation I Torch Roofing/Tar Kettle <br /> I I Fire Pumps n Waste Tire Storage ANNUAL <br /> I Fire Works <br /> Flammable Application- ANNUAL I I Valuation of Project <br /> I I Fuel Tanks <br /> I I Other: I <br /> Contractor Company NOVA U- Nti111(g .SeeV' /14' I <br /> Signature o • Registered Y / N Fee Current I Y / N <br /> Address I P.0 Y,PX, LiciaG i lO- , FL 336r77/ I License# <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I I License # I <br /> PLUMBER Company <br /> Signature Registered Y / N I Fee Current I Y / N j <br /> Address I 1 License # I <br /> MECHANICAL Company I <br /> Signature Registered Y / N I Fee Current I Y/ N J <br /> Address 1 I License # I <br /> OTHER Company I <br /> Signature Registered Y / N I Fee Current 1 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.(Mechanicai 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 />