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/. Fax - 813 -780 -002 <br /> 813- 780-0020 City of ZephyfiitlsFire• ZiJv _ _ - -- <br /> Permit Application <br /> Received - - Phone Contact for Permit <br /> Date eived , .. ... - <br /> I � <br /> e..._ � r - owners Phone ME I-4e2.1 I B-1() Owners Name I t?, \ e 1 .W <br /> 6L O ( ' \∎x9 7- 0p \AQ' 4, <br /> Owners Address I Titleholder Phone Number 1 1 1 Fee Simple Titleholder Name I <br /> Fee SimpleTltiehoider Address <br /> Lot # <br /> Sub Division <br /> Job Address ` I I <br /> Parcel # .: ..._ :: <br /> :. ._ <br /> ❑ F.MTMgation Tent <br /> ED C and Waste Storage - ANNUAL Q t Material R II or RQ Facility) ANNUAL <br /> ED Comm Exhaust Kitchen Hood/Duct <br /> ❑ Controlled Bum n Hood kistEdlation <br /> ❑ Emergency Generator < 30 kw n LP/NahNal Gas- installation <br /> ri > 30 kw <br /> n LP/Natural Gas ANNUAL Sale <br /> Emergency Generator ED 1:::1 Places of Assembly-ANNUAL <br /> Fire Protection Maintenance - ANNUAL 5�! 4 —iii <br /> ❑ 0 0 0 ® I ® _ ❑ tonal Bum <br /> Sprinkler <br /> Fire Alarm ❑ 0 0 0 I 1 Sparlders <br /> Hood Cleaning 0 0 ' I n y st System Installations <br /> Hood Suppression [J 0 0 0 I I n ten' (S Sys) <br /> r-i n Torch Roofing/far Kettle <br /> Fire Alarm Installation <br /> pi ❑ Waste The Storage ANNUAL <br /> Fire Pumps <br /> Fire Works ' Valuation of Project <br /> Flammable Application- ANNUAL <br /> Fuel Tanks <br /> III a 1 -r:' I <br /> mm ®.ommm� - -■ .., Company <br /> Contractor to. Y / N Fee Current Y / N <br /> Signature - �- - <br /> =+�-- , 14 C. License I I <br /> Address -" ` '�h"_'�� -1 t.. <br /> ELECTRIC Registered Y/ N ( Fee Clawed Y 1 N <br /> Signature � 1 License* Address I I <br /> PLUMBER <br /> i Registered 1 Y/ N I Fee Current I Y/ N <br /> Signature ( Lk�e # I <br /> Address I I <br /> MECHANICAL' I Company YIN <br /> Fee Cum YIN I N <br /> Signature I <br /> Address I I License* 1 I <br /> OTHER <br /> Registered Signature I L Y/ N f Fee Current I Y/ N <br /> License* I <br /> Address' <br /> i <br /> Directions: <br /> Fill out application completely. notarized (Or. copy af signed with owner) & Contractor sign back of application. <br /> -If over $2500, a Notice of Commencement is required (Mechanical work over $5000) <br /> Supply two (2) sets of drawings with applicable documentation Parcel # - obtained from Property Tax Notice (MtpJ/aPPr •Pas v can) <br /> Allow 10-14 days for review after submittal date. <br /> 1 <br />