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i i k N 8 1 <br /> 813 -780 -0020 City ofZephyrhilisFire• Fax- 813 - 780 -0021 <br /> Permit Application <br /> Date Received 4- p? Q q Phone Contact for Permit 996 J by t <br /> Owner's Name 4i:Sde,11 (nr/-ie Owner's Phone Number , 8)3 183 796Q _ <br /> Owner's Address Co SS S G -\ ` Bl J c. 3 3 Sal 2 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address } m� s <br /> r <br /> y. "'q's����p' „ w , ., °: .ru -..., :.: '.•*,..:! «a ,':'-:,, . «a. . z "�''�'k:�ir�:...... .... ... ,:. .. .,.....,. w....._ .. ..,... ,..., ., <br /> Job Address ‘ t-5-15- G 60 2e,"ylh, /+f 335 2 - , Lot# <br /> Sub Division <br /> Parcel <br /> r I Bio-Hazard Waste Storage - ANNUAL J I Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n - Controlled Bum I I Hood Installation <br /> n Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw J I LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL J I Places of Assembly- ANNUAL <br /> _ IutriyI 'I berm] Fri iUtner 1 <br /> Sprinkler ID ❑ I Recreational Bum <br /> Fire Alarm I ❑ ❑ ❑ I I Sparklers <br /> Hood Cleaning E ❑ ❑ ❑ I J I Sprinkler System installations <br /> Hood Suppression C ❑ >0 ❑ I 1 Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation I Torch Roofing/Tar Kettle • H Fire Pumps Waste The Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL { I Valuation of Project <br /> Fuel Tanks <br /> n Other: I <br /> Contractor f/ Company <br /> Signature / - `'r�� S '! / Registered Y / N Fee Current Y / N - <br /> Address I License* 1 <br /> ELECTRICIAN Company <br /> Signature • Registered _ Y / N - Fee Current Y / N <br /> Address 1 License* <br /> PLUMBER Company <br /> Signature Registered ` Y / N Fee Current I Y / N <br /> Address I License # <br /> MECHANICAL Company <br /> Signature Registered Y / N _ Fee Current I Y / N <br /> Address • License # J <br /> OTHER Company <br /> Signature Registered Y / N Fee Current I Y / N <br /> Address <br /> 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.(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 />