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813-780-0020 City of ZephyrhillS Fire Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received I Phone Contact for Permit <br /> Owner's Name /V OVA Se,efr/GE /NC. Owner's Phone Number I 1 <br /> Owner's Address I 14 - ° • d 4'966. 7;f00,l ,/• .33a V9 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address 1 <br /> � G 3 1 • r/A± y am. <br /> Job Address MC y ()NA L� , $ / Vu. �D , 2EPiQ'RAf LLS, 33SC10 Lot # <br /> Sub Division Parcel # <br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> El Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> F Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> lUtnyl'Semi) Fri Other <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum CLEANNO WILL 2,6,Oi1E <br /> Fire Alarm n ❑ ❑ ❑ I 1 I 1 Sparklers O N MAQ.C44 2,S. <br /> Hood Cleaning j$( ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ I n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL ( Valuation of Project <br /> I Fuel Tanks <br /> F Other: <br /> ' is ;?.3�a».s...:srM- st<w °...;sa;s .sue °,�:s?e^.rr?.�.r:iih' *•<:::ae.?r;:s...�w�.::3:.. <br /> Contractor _ Company AIOVA SER2 V{ GEj 111C • I <br /> Signature b�"� FE.r�111GZ1 Registered Y / N I Fee Current I Y/ N I <br /> Address ( P.O &O,(, LAG& 1AMPsl, F1. 336991 License# I <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I I License # I <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N' <br /> Address I I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y / N J Fee Current I Y/ N <br /> Address I I License # I <br /> OTHER Company I <br /> Signature Registered Y/ N J Fee Current I Y / N I <br /> Address 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 />