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813 - 780 -0020 City of Zephyrhilisfii@o2^ Fax-813-780 -0021 Permit Application Date Received - - Phone Contact for Permit Owners Name - - r A regj , 1 Owners Phone Number ) 1 I 1 I i / y Owners Address " f I' - �. i d� / = , / Fee Simple Titleholder Name Titleholder Phone Number Fee SlmpieTitletolderAddress I 1921111111111•111111111■■• AIM Job Address 1 ? & Z1 # II 43; 1 Lot* I Sub Division 1 I Parcel # l 44 ❑ Bio- Hazard Waste Storage - ANNUAL ❑ Fumigation Tent ❑ Comm Exhaust Kitchen Hood/Duct ❑ Hazardous Material (Tier II or RD Facility) ANNUAL ❑ Controlled Bum ❑ Hood Installation ❑ Emergency Generator < 30 kw ❑ LP/Nahsal Gas - Installation n Emergency Generator > 30 kw r-i LP/Natural Gas- 4NNUAL Sale Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL Spdnldsr ❑ ❑ ❑ ❑ ❑ Recreational Bum Are Alarm ❑ ❑ ❑ ❑ 1 1 ❑ sparklers Hood Cleaning ❑ ❑ ❑ ❑ I 1 ❑ Sprinkler System Installations - Hood Suppression W ❑ l CI 1 1= Standpipes (SprWder Sys) E: Fire Alarm installation ED _ Torch Roofs g/Tar Kettle • Fire Pumps - .. _ ❑ Waste The Storage ANNUAL Are Works Flammable Application- ANNUAL I I Valuation of Project Fuel - , . 1:7-1 I Contractor Cornpany I Signature A. . i _Admen.- I Y/ N I Fee Current I Y/ N J lis Address II i ¢:� -f lY --.W .PIGS / / ,,, # Company a�iG G/ig4PO 1 ) ! ' 5,4/1 Registered 1 Y / N I Fee Current Y / N I I Address I I License # I I PLUMBER Company I Signature Registered I Y/ N I Fee Current I Y/ N I Address I I License it I I MECHANICAL Company I Signature I Registered I Y/ N 1 Fee Current I Y/ N I Address I I License # I I OTHER Company I Signature ( Registered I_ Y / N ' 1 Fee Current I Y / N I Address I 1 License* I I Directions: FM out application completely. Owner & Contractor sign back of application, notarized (Or. copy of signed contract with owner) Mover $2500, a Notice of Commencement is required (Mechanical work over S5000) Supply two (2) sets of drawings v4th applicable documentatlon - Aliow 10-14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http:/ /appraiser.pascogov.com)