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iI <br /> q <br /> 813- 780 -0020 City of Zephyrhilis Fire 1 Fax -813 -780 -0021 <br /> Permit Application (�f <br /> Date Received I Phone Contact for Permit 13o 11 J -i'5 1182 q"_3 1 <br /> Owner's Name I TA C C7 _. e � # y 8 a Owner's Phone Number I 727 3 8 C I .3 y6 <br /> Owner's Address 7 313 GA // Nit/A. <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I n I <br /> Job Address 73/.3 G,4( ( �.d , Lot# <br /> Sub Division Parcel # <br /> n Bio- Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RO Facility) ANNUAL <br /> n Comm Exhaust Kitchen Hood /Duct n Hood Installation <br /> n Controlled Burn n LP /Natural Gas - Installation <br /> n E mergency Generator < 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> n E mergency Generator> 30 kw I I Places of Assembly- ANNUAL <br /> n F ire Protection Maintenance - ANNUAL n Recreational Burn <br /> IQtrlyl (Semi � Other <br /> Sprinkler n ID ❑ ( I Sparklers <br /> Fire Alarm I ❑ (21 0 I 1 I ( Sprinkler System Installations `0 — <br /> Hood Cleaning I ❑ ❑ ❑ I 1 I I Standpipes (Sprinkler Sys) �� <br /> Hood Suppression IZ. ❑ `YL ❑ I 1 I I Torch Roofing/Tar Kettle <br /> In Fire Alarm Installation n Waste Tire Storage ANNUAL <br /> F Fire Pumps <br /> Fire Works <br /> Flammable Application- ANNUAL 1 ( Valuation of Project <br /> Fuel Tanks <br /> (n O ther: <br /> Contractor / / 1 Company ' • = Al -6 ' i t '* . <br /> Signature /� Registered j U Fee Current Qu� <br /> Address I3tt9 N,.) `2nrb NAiAVAi I et_ -317 1 I License# 3 [1 ?� ' 701)Q0 1 2-oo¢ <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N 1 Fee Current 1 Y / N 1 <br /> Address I I License # I <br /> PLUMBER Company I <br /> Signature Registered Y / N 1 Fee Current I Y/ N I <br /> Address I I License # I I <br /> MECHANICAL Company ( <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 I Fee Current 1 Y/ N 1 <br /> Address I I License # I <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 />