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813 -780 -0020 City ofZephyrhillS Firer Fax- 813 - 780-0021 i. <br /> Permit Application <br /> Date Received 1 I Phone Contact for Permit 1 <br /> Owner's Name G.yr,.c -lo.S J z7' 2-62,1•($/,-4 <br /> 1 Owner's Phone Number } ?i.3 1 1 2W 1 1 7 ?02 <br /> Owner's Address IS`Z�C �.t � (/�j <br /> S �� / <br /> Fee Simple Titleholder Name I I Titleholder Phone Number I 1 1 1 <br /> Fee Simple Titleholder Address I <br /> Job Address I Lot # I �.~ ��: <br /> Sub Division 1 Parcel # ) I <br /> Storage Fumigation <br /> Bio- Hazard Waste Sto a - ANNUAL 1 1 gation Tent <br /> n Comm Exhaust Kitchen Hood/Duct I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> I - I Emergency Generator < 30 kw a LP/Natural Gas - Installation <br /> I Emergency Generator > 30 kw I] LP/Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL r Places of Assembly- ANNUAL <br /> lSemil ®Li.+1 1 <br /> Sprinkler n ❑ ❑ ❑ El Recreational Bum <br /> Fire Alarm IT ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning Ej ❑ ❑ ❑ I I [] Sprinkler System Installations <br /> . Hood Suppression f.R ❑ A ❑ I 1 n Standpipes (Sprinkler Sys) <br /> 7 Fire Alarm Installation I Torch Roofing/Tar Kettle <br /> Fire Pumps I Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application ANNUAL ' ( Valuation of Project <br /> Fuel Tanks <br /> 0 Other. I <br /> Contractor Cony I <br /> Signature Registered Y / N, Fee Current I Y/ N I <br /> Address I License # <br /> ELECTRIC Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I License # ( I <br /> PLUMBER Company 1 <br /> Signature Registered Y/ N 1 Fee Current I Y/ N 1 1 <br /> Address I License # I <br /> MECHANICAL Company <br /> Signature Registered Y/ N j Fee Current I Y/ N 1 <br /> Address I I License # I I <br /> OTHER Company etri ��d L L <br /> Signature ,- � 2,,... - G(.1�_ Registered Fee Current <br /> Address <br /> License <br /> ter.. ., <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 5 2500. 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 (httpJ /appraiser.pascogov.com) <br />