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813ae0 -0020 City ofZephyrhillsFire• Far -813 -780 -0021 <br /> Permit Application <br /> Date Received <br /> Phone Contact fvr Permit 1 <br /> ., :s._., .WIE.... a 3..:.»: .,..-- ,„.....,.— ,......;.,,r... , fi e - __,.., ..:........... .:.:: <br /> Owner's Name l oiNA -\ P'� t I l end Owner's Phone Num je J -7KZ -- ) -- r7() <br /> Owner's Address 6 C3 q / Y { f 7 ✓l YC V` t) 1 S 73 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple - Titleholder Address j <br /> m1S .... q2. ,..... N. it u ?i <br /> Lot# <br /> Job Address <br /> Sub Division Parcel <br /> I Bio-Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n - Controlled Burn 1 I Hood installation <br /> Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL r Places of Assembly- ANNUAL <br /> l tltrly1 Jsemil J 5 1 ' utner <br /> Sprinkler n ❑ ❑ ❑ I I Recreational Bum <br /> Fire Alarm ❑ 0 ❑ I I Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ 1 1 I 1 Sprinkler System Installations <br /> Hood Suppression El ❑ ❑ in , I I I Standpipes (Sprinkler Sys) <br /> :n Fire Alarm Installation I 1 Torch Roofing/Tar Kettle <br /> Fire Pumps 1 1 Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL ( Vaivat on of Project <br /> Fuel Tanks <br /> El Other <br /> Contractor Company . <br /> Signature \�� (AA—....._ , Registered Y / N 1 Fee Current I Y / N I <br /> • <br /> Address I License # <br /> ELECTRICIAN Company <br /> Signature - • Registered Y / N Fee Current I Y / N <br /> Address 1 License # <br /> PLUMBER Company <br /> Signature Registered Y / N Fee Current Y / N J <br /> Address I I License # I I <br /> MECHANICAL Company <br /> Signature Registered Y / N Fee Current j Y / N <br /> Address I License # <br /> OTHER • Company <br /> Signature Registered Y / N _ Fee Current Y / N j <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.(Meehanical 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 /> • <br /> • <br />