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Fax-813-780-0021
<br /> 813 City of Zephyrhllls Fire
<br /> Permit Application 1 `
<br /> Phone Contact for Permit . LL
<br /> Date Received • r ,rra .. atarraraw eroemm�.cm
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<br /> •-,..,. iC�YIG.�,r d 6 - •nffs pwner Phone Number :!3 I i l vK`(p I
<br /> • Owner's. Name _ w
<br /> Owner's Address Address • 62SI 4 ..Kt" - �2. •/. .z�• - '1 f• ter.
<br /> ,j� / 1 - l
<br /> Fee Simple Titleholder Name j y a ,,, r i•rli Titleholder Phone Number I g ( p , 1 7 0 P - 1 I rs1
<br /> Fee Simple Titleholder Addreay lEllai ^.ti•, ...
<br /> ..eb Address
<br /> r :YI^Y':.(,;!rl „abT !HIII$"tTn'� e 1 , .
<br /> p/ Lot # e- /6 •
<br /> .lab f __aa // __ J p �_ O � �� � � _ O lvO D �� ,,,��
<br /> Sub Division 1 t V1� 8 � --� Ul Y1.I # .. . . ,.,T r ,e,nr • 1 ' rRW! NR p�NfA : �IDII� 'M1'A�W73",.`ar.4NRMRBYRr.I! -g' 1:.
<br /> .-..,:, e 5m! a �R, �Tr1^ �t ?q;al'nrh?f;1�T�::N!¢IM,C"�I _. �.
<br /> E Bio-Hazard Waste Storage - ANNUAL n Fumigation Tent
<br /> a Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> ID Controlled Bum Q Mood IrlsInllaliu -1
<br /> n Emergency Generator < 30 kw = LP/Natural Gas - Installation
<br /> 0 C me rig cnoy Ccnernter 1 30 kw • Ln LP/Natural Gat ANNUAL Sale
<br /> IJ Fire Protection Maintenance - ANNUAL = Places of Assembly- ANNUAL
<br /> ® r Ea” •I
<br /> Sprinkler ❑ ❑ ❑ = Recreational Bum
<br /> Fire Alarm Ej 0 ❑ 0 1 LI Spenders .
<br /> Hood Cleaning !7 ❑ ❑ I1 I Sprinkler System Installations
<br /> Hood Suppression 2" ❑ 0 i 1 ` I Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Itlslallaliurl a Torch Roofing/Tor Kettle -
<br /> Fire Pumps Tire Storage ANNUAL
<br /> Fire Works
<br /> Flammable Application - ANNUAL 1 / 7-s V aluation of Project
<br /> � n Fuel Tanks .
<br /> _.,,,.._...,� .,
<br /> - , ;0 ,, I � t h er: v. F? Lim Nd!•rntrISRII!tI1P. ,T7F'7�?c�?'.IF.?: r....:4,,.s...r...a,rwa,.ruip I!st' ompr 73tomrtei 'Pratmgorro"!JP,'•lF:rt'*In„ 1St! 'iPii tenet'"!!:"..,' Y^!v.,:t. fi ..w.rn`*- ..... 1 ;t'r•,:.
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<br /> Contractor ., .. ,! COMPanY � AL ti - • •
<br /> Signature K'•�^� ! Registered Ilt Fee Current Ir1_,211
<br /> Address f tJ 60? v27 V/ f -4,flc, .rj(n'yi l Ucense tk I s 9(e acoroo t eft V j
<br /> ELECTRICIAN Company l
<br /> Signature Registered Y/ N 1 Fee Current 1 Y/ N • )
<br /> Address 1 l • License* ( l
<br /> PLUMBER • .Company l
<br /> Signature , • Registered , Y/ N 1 Fee Current 1 Y/ N
<br /> Address l l License # ( 1
<br /> MECHANICAL Company - l
<br /> Signature Registered Y / N 1' Fee Current . l Y / N 1
<br /> Address 1 1 License* 1
<br /> OTHER Company • l
<br /> Signature Registered I Y / N 1 Fee Current ( Y / N 1
<br /> Address 1 1 �
<br /> Li n e #
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<br /> -ro
<br /> Directions; _.
<br /> Fill out application oomplctely. •
<br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) •
<br /> if over 32500, a Notice of Commencement is required (Mechanical work over 35000)
<br /> Supply two (2) sots 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)
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