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813- 780 -0020 City of Zephyrhii)s Fira. Fax- 813 - 780 -0021 Permit Application Date Received Phone Contact for Permit 1-1..., � �I _ Owners Name !_A _ . i = �i -�/ E rev's Phone Number . 1 I 1 1 I Owners Address i ?* - C Fee Simple Trtieholder Name I I Titleholder Phone Number I 1 1 1 I Fee Simple Titleholder Address Job Address I I # Sub Division I 1 _ ❑ Bio- Hazard Waste Storage - ANNUAL ❑ Fumigation Tent ED Comm Exhaust Kitchen Hood/Duct 1::::I Hazardous Material (Tim liar RQ Facility) ANNUAL ED Controlled &en n Hoad iron ❑ Emergency Generator < 30 kw 11 LP/Natural Gas-Installation ❑ Emergency Generator> 30 kw r) LP/Natural Gas - ANNUAL Sale ❑ Fire Protection Maintenance - ANNUAL ❑ Places of Assembly-ANNUAL Sprinkler Li ❑ O ❑ ❑ Recreational Bum Are Alarm ❑ ❑ ❑ ❑ 1 1 ❑ Spenders Hood Cleaning E ❑ ❑ RI 1 n Sprinider System Hood Suppression ❑ ❑ ❑ ❑ 1 1 n Standpipes (Sprinter s 0 Fire Alarm installation ❑ Torch Rooting/Tar Kettle Are pumps 1l Waste Tim Storage AtIIUAL Fire Works Flammable Application- ANNUAL t I Valuation of Project Fuel Tanks E other: 1 Contractor Company Signature Registered Y/ N 1 Fee Current 1 Y/ N J Address I I License* I I ELECTRICIA1 company Signature Registered ( Y/ N 1 Fee Current I Y/ N I Address I License # I 1 PLUMBER I Company Signature I - Registered Y/ N J Fee Currant I Y/ N 1 Ads I 1 License # • I Company Signahre Registered I Y/ N 1 Fee Current 1 Y/ N J Address I I License* I I OTHER Company -5 r_D i2 t .,?e E �,+ a, 0 Signature ''' ' :�-'l� �� ' N 1 Fee corer* 1 Y / N 1 Registered Address �1 License # c z " —• _6cG i L , , Dkections: Fdi out application completely. Owner & Contractor sign back of appNcatlon, notarized (Or, copy of signed coiMract with owner) ff over $2500. a Notice of Commencement is required (Mechenicai wok over 55000) Supply two (2) sets of drawings with applicable documentation Allow 10-14 days for review after submittal date. Parcel # - mined from Property Tax Notice (httpl/appraiser.pascogov.com)