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813 - 780 -0020 Ci ty p h of Ze rhills Fire Fax - 813 -780 -0021 <br /> y <br /> Permit Application <br /> C24. Phone Contact for Permit <br /> Date Received <br /> �.. d� <br /> • Owners Phone Number �� ��(� 1 Owners Name �,,/� f //�� ry/ _ <br /> Owner's Address 1 ,..5 s7 64 / 1 fi L Y " " • 7 �iiJ i� 1 / r <br /> �� <br /> I Titleholder Phone Number ( 1 1 I <br /> Fee Simple Titleholder Name I <br /> Fee Simple Titleholder Address -. .. r_ _, � - �. . <br /> Lot # <br /> Job Address ( I <br /> Sub Division 1 Parcel # <br /> CI Bio-Hazard Waste Storage - ANNUAL Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Comm Exhaust Kitchen Hood /Duct ED Hood Installation <br /> ED Controlled Bum a LP /Natural Gas - Installation <br /> Emergency Generator < 30 kw LP /Natural Gas - ANNUAL Sale <br /> El Emergency Generator > 30 kw ED Places of Assembly- ANNUAL <br /> Fire Protection Maintenance - ANNUAL I-1 Recreational Bum <br /> r y 'Semi' Eall 'Other I ❑ <br /> Sprinkler 0 ❑ ❑ ❑ Sparklers <br /> Fire Alarm ❑ ❑ ❑ I I I Sprinkler System Installations <br /> Hood Cleaning 0 ❑ ❑ ❑ I 1 El Standpipes (Sprinkler Sys) <br /> Hood Suppression 0 ❑ ❑ ❑ I I E Torch Roofing/Tar Kettle <br /> Fire Alarm Installation 0 Waste Tire Storage ANNUAL <br /> Fire Pumps <br /> Fire Works I <br /> Flammable Application- ANNUAL Valuation of Project <br /> Fuel Tanks I <br /> 0 Other <br /> ..� .:4d.�S.x VIZ. »-,,.�.✓r'Td ..:��S.w. 3��- �. rC w'- �t, ��+ ?" F5& 1�rR•. ceN? �, .?Y_iXfW><.�+3t= RP,�.k'?..�3�SY ,, ' �. mcfx.. eb'.L.:' 3 '� - �R€ _. e s�. PiH - F•*'*Sw� -" <br /> / Company <br /> Registered I <br /> Contractor I /J I <br /> Signature X r d Y/ N I Fee Current I Y/ N I <br /> Address I I License* I <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address 1 I License # ( I <br /> PLUMBER Company <br /> Signature Registered l Y/ N � Fee Current I Y/ N I <br /> Address I I License # I I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # ( I <br /> OTHER Company I <br /> Signature Registered Y/ N 1 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 />