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Ma j 1° 09 09:10a Southeastern 4078309602 p.3 <br /> 813-780-0020 _ <br /> City of.ZephyrhiilsFim Fax- 813 - 780 -0021 • <br /> • Permit Application <br /> . Phone Contact for Permit 0 7 %� 0 'WANE/ <br /> Date Received .,. � ..,._ ,.. .,.:�.._::.�:,- �.ry...,. <br /> Owner's PIarne .1 ( /a C/C S ` • - • - I owners Phone Number Mill 17n 1 I DS I l 1 <br /> Owners Address I 5 0 &A 1 I Q1 u t-+ p tl k1 a Vl a+,5 • PI '3 5 7 / (� ]� lI <br /> Fee Simple Titleholder Name I Al[ 4 1 Titleholder Phone Number 1 I T 11 1 t <br /> Fee Sample Titleholder Address I A �. s_ -- '`` <br /> Job Address 1 <br /> , .. 5 i t I I 8► �� - <br /> • 1 . <br /> 1 <br /> Seb man 1 �1� A Parcel* . I <br /> Sub �.i.�.:.:: - .....�:� 4 I ::,.........s, _ ._,. �._ <br /> n 8io -Hazard waste Storage - ANNUAL = Fumigation Tent <br /> ❑ Conm Exhaust Kitchen Hood/Duct ❑ Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> ❑ Controlled Bum ❑ Hood Installation <br /> ❑ Emergency Generator < 30 kw . . ❑ LP/Na aa1 Gas4astallation <br /> ❑ Emergency Csenerapw> 30 toe ❑ LP/Nahral Gas - ANNUAL, Sale i <br /> Places of Assembly- ANNUAL • ED Fire Protection Maintenarhee ANNUAL I-1 l I/ <br /> Sprinkler 1_1 D D ❑ n Reue®baral Bum <br /> Fee Alarm ❑ D / ❑ 0 11 ED Spadders • • <br /> Hood Clearing R' D 0 1 1 n Sprinkler System k>slatlabons <br /> Hood Suppression ❑ D D 0 1 1 .0 StandPiPes (Swinider SYs) <br /> ❑ Fire Alarm Installation n Torch Roofing/Tar Kethe <br /> Fire Puy • ❑ Waste Tae Storage ANNUAL <br /> Fee works 1 • Flammable Application- ANNUAL Valuation of Project <br /> Fuel Tanks <br /> ❑ other- I �.. ... <br /> Contractor S •i iw {D626TEC >roc. $c,LT . Company 1 5oc� t TNG 76. 032pZ0.G7 /D...• 6 ( <br /> Signature c---- L Regrstlered 'Y N I Fee ctment I Y/ N I <br /> Address ' . O iv ie. ,i- - _ . d: 1 _.. UNITrs$ It • :. <br /> cc cr IM4 Lpouq wood p.. 32'7SU .. Company I <br /> Signature Registered 1 Y/ N I Fee Currant I Y/ N. I <br /> Address I License # <br /> PLUMBER any I <br /> Signature Registered I Y/ N I Fee Current I Y/ N I <br /> Address I 1 License it 1 1 <br /> MECHANICAL' Company 1 <br /> Signature Registered f Y/N I Fee Current I Y/ N <br /> Address (t 1 License # { <br /> OTHER 1 Company <br /> Signature I Registered Y/ N I Fee Current I Y/ N I <br /> Address • License # �.� <br /> Directions: <br /> FIII out application completely. <br /> Owner & Contractor sign back of application. notarized (Or, copy of signed contact with owner) <br /> If over $2500, a Notice of Commencement is requ ired.(Mechanical work over SS000) <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 (hupJ!appraIser.pascogov.com) <br />