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813-780-0020 City of ZephyrhillS Fire. Fax -813- 780-0021 <br /> Permit Application <br /> Date Received W, /_ <br /> Phone Contact for Permit <br /> Owners Name I C /7 17/5 I Owner's Phone Number I g / 3 11 >. $S I dSi -- <br /> nets Address I <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> Job Address 76 %' 3 Gal/ B /1/ d Lot # <br /> Sub Division I Parcel # I <br /> Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RC) Facility) ANNUAL <br /> I Controlled Bum I-1 Hood installation <br /> E l Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale i' <br /> El Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL n (/;'� <br /> l ttrlyl (Semi) raj Other 7 ,,, <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm a ❑ ❑ • I I n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I I I I Sprinkler System Installations <br /> Hood Suppression E ❑ ❑ ❑ 1 I n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> ER Flammable Application- ANNUAL 1 ( Valuation of Project <br /> Fuel Tanks <br /> Q Other: I <br /> . 'mammonism <br /> Contractor Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y/ N J <br /> Address I <br /> 1 License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N . 1 Fee Current I Y/ N I <br /> Address I 1 License # I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y/ N j <br /> Address I I License # I I <br /> OTHER Company A ,b r-- ,Se alf/ ly Se. It vices <br /> Signature Registered Y/ N I Fee Current Y/ N I <br /> Address I-4-1W W 14/4! ter.../ r , tt v ii I b a fL 3 <br /> 33 1eV l License # Q <br /> Directions f <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 />