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813- 780 -0020 Ci ty ofZ 1'1 <br /> p y e h rhillsFire' V / Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received 1 I Phone Contact for Permit <br /> ar�yar!.., :Mtix=x a <, W s asp^.• !w :, <br /> Owne f4 / //1054 Zif f' l Owner's Phone Number c5 19 � <br /> / 3 / 44-9/_ Owner's Name J / <br /> Owner's Address <br /> / /or v " J7/ /l41, v? /vi e'a/110A F/G+. 3'.15 1 <br /> ! Titleholder Phone Number _ , <br /> Fee Simple Titleholder Name J <br /> Fee Simple 'Titleholder Address <br /> ..... SS06 Nr Gal/ 7/k2 j Lot# <br /> Job Address l <br /> Sub Division 1 <br /> Parcel <br /> a a.i,:U...:auJ.- •t:.......�r. "�w� "wVmd�»kdih >aL4r.'� '. -•' "" - •• <br /> 1 I Bio-Hazard Waste Storage - ANNUAL I Fumigation Tent <br /> 1 1 Comm Exhaust Kitchen Hood/Duct 1 Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I ( - Controlled Burn I 1 Hood installation <br /> Emergency Generator < 30 kw 1 I LP /Natural Gas - Installation <br /> I Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL ` Places of Assembly- ANNUAL <br /> JUtriy)' Semi) ram Ivtner 1 <br /> Sprinkler ID ID ID Recreational Bum <br /> Fire Alarm 1 1 ❑ ❑ ❑ 1 1 1 1 Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ 1 1 1 1 Sprinkler System Installations <br /> Hood Suppression 1 1 ❑ ❑ ❑ 1 ( 1 1 Standpipes (Sprinkler Sys) <br /> TT Fire Alarm Installation • 1' Torch Roofing/Tar Kettle <br /> 1 1 Fire Pumps 1 Waste Tire Storage ANNUAL <br /> I I Fire Works <br /> 1 1 I Flammable Application- ANNUAL 1 1 Valuation of Project <br /> ,n Fuel Tanks <br /> Other: a <br /> Contractor �,/ Company <br /> Signature i G Registered Y / N Fee Current Y / N <br /> Address 1 I License # <br /> ELECTRICIAN Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address License # <br /> PLUMBER Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address License # 1 <br /> MECHANICAL Company <br /> Signature Registered Y / N Fee Current I Y / N <br /> Address 1 License # <br /> OTHER. Company <br /> Signature Registered Y / N Fee Current - Y / N <br /> Address License # <br /> r!�a�� <br /> Directiens: <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.(Mechanicat 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 />