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813 78 0 -0020 City of ZephyrhillsFire. Fax -813- 780 -0021 <br /> -A,. Permit Application <br /> Date Received - Phone Contact for Permit <br /> Owner's Name S TMPT,FXGRTNNELL Owners Phone Number 813 626 5 4 8 2 <br /> Owner's Address 4701. Oak Fair B1vd TAMPA FL 33610 <br /> Fee Simple .Titleholder Name ' Titleholder Phone Number <br /> Fee Simple Titleholder Address . <br /> sy:-d,: `-,z -_ ;c r,&- a" at= - L ;.. 2: x s tea;, - F - ^"' ? y i'a- y.- 2. <br /> «�.,*zsc�`.�... -• s,'x'•.� - �.�� �': ue ..L.- �;`� -: a,� ....� :,,�. w � -=�'-' <br /> Job Address <br /> ( Q 1 19 C ckl1. ?■ - Ze,PArt ■lts cL T >541 Lot# <br /> Sub Division Parcel # <br /> w''.15,01-4, me •`- _.. aa:,,.G- .s �- r • r "- -.tz .z— ,...4. - <br /> I Bio- Hazard Waste Storage - ANNUAL Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct Hazardous Material (Tier It or RQ Facility) ANNUAL <br /> I . Controlled Bum Hood Installation <br /> I Emergency . Generator < 30 kw LP /Natural Gas - Installation <br /> I . I Emergency Generator > 30 kw LP /Natural Gas - ANNUAL Sale <br /> I . Fire Protection Maintenance - ANNUAL • Places of Assembly - ANNUAL <br /> lUtrlyf JSemiI MA imam <br /> Sprinkler . FA ❑ • ❑ ►' . • I Recreational Burn <br /> . Fire Alarm I I ❑ ❑ ❑- I I I I Sparklers <br /> Hood Cleaning I C I C I D I I I I Sprinkler System Installations <br /> • Hood Suppression I I ❑ ❑ O I I I I Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation • Torch Roofing/Tar Kettle - <br /> Fire Pumps ' - I Waste Tire Storage ANNUAL <br /> L . I Fire Works • <br /> Flammable Application- ANNUAL I Valuation of Project <br /> ,: ( Fuel Tanks • <br /> I Other: ) • <br /> Contractor / Company 3 (Yri' Kfcer.- - . e( <br /> Signature Registered Y/ N i Fee .Current I' Y / N J <br /> • s <br /> Address .. ...- , . I : _. License # I . • <br /> ELECTRICIAN . . Company .. <br /> Signature , - Registered - Y / N I .,Fee Current I Y / N ; 1 <br /> Address : ( License # . , - .,, <br /> PLUMBER , , ,' Company <br /> Signature •_ Registered Y1 N •1 Fee Current' I Y 1 N' I <br /> Address • ( License # - I - I <br /> MECHANICAL Company <br /> Signature . Registered Y / N ! Fee Current I Y / N I <br /> Address I I License # I I <br /> OTHER - Company • - <br /> - <br /> Signature Registered Y/ N I Fee Current I Y/ N _, <br /> Address License # _ <br /> _- ..,r s .w... z s' "-- -- -�. : _ ,,,-, :.. -r ay - ^-= : ate <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 (http: / /appraiser.pascogov.com) <br />