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/ ye6 City ofZephyrhillsFire• Fax - 813 -780 -0021 <br /> 81 3 - 780 -002 <br /> al� Q <br /> Permit Application <br /> L - <br /> ' . - Phone Contact for Permit <br /> Date Received <br /> Owner's Name � <br /> V /NC. DBI4 3 uQ wA�l Owner's Phone Number <br /> I S� %Th sq. P t Ft- 337 34 <br /> Owner's Address L V''9 - 7it 34 Ct. I 1 <br /> Titleholder Phone Number J <br /> Fee Simple Titleholder Name <br /> Fee Simple-Titleholder Address vim} _ "_A «..,s k • <br /> .x,,,� .s ti' 3354'2. <br /> S V-7(.... Lot f <br /> Job Address 1 -- VVO Zep)'}'4IR -4%LA- f 1 <br /> 5406 Cr -'t� Q 1 I Parcel # <br /> Sub Division „�, -n�T, <br /> Bio-Hazard Waste Storage - ANNUAL <br /> Fumigation Tent <br /> Comm Exhaust Kitchen Hood/Duct Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n - Controlled Bum l I Hood Installation <br /> f I <br /> Emergency Generator < 30 kw 1 1 LP /Natural Gas - installation <br /> J I LP /Natural Gas - ANNUAL Sale <br /> Emergency Genetator> 30 kw <br /> Places of Assembly- ANNUAL <br /> Fire Protection Maintenance - ANNUAL ry�rr 74 �� <br /> )utnyl Therm] f r IUtner ,� qi 5pr IQ ❑ ❑ 1 1 Recreational Bum / <br /> Fire Alarm 1 1 ❑ ❑ ❑ 1 I 1 1 Sparklers <br /> 1 <br /> Hood Cleaning n ❑ ❑ ❑ 1 ( 1 1 Sprinkler System Installati --"` -- <br /> Hood Suppression ❑ ❑ ❑ 1 l 1 1 Standpipes (Sprinkler Sys) <br /> 1 1 Fire Alarm installation 1 1 Torch Roofing/Tar Kettle <br /> I Fire Pumps 1 1 Waste Tire Storage ANNUAL <br /> 1 Fire Works <br /> Flammable Application- ANNUAL . p Valuation of Project <br /> Fuel Tanks <br /> fl Other: 1 <br /> Contractor ' Company <br /> ontractor Company L- P -r A- 1 N(L <br /> Signature t, ' '._ ___ Registered Y / N I Fee Current 1 Y / N <br /> Address a - - <br /> License # <br /> ELECTRICIAN Company L . <br /> Signature Registered Y / N 1 Fee Current Y / N <br /> Address License # 1 <br /> PLUMBER Company <br /> Signature Registered Y / N 1 Fee Current Y / N <br /> Address 1 License # 1 <br /> MECHANICAL Company <br /> Signature Registered Y / N I Fee Current Y / N •Address License # 1 <br /> OTHER. Company <br /> • <br /> Signature Registered Y / N Fee Current Y / N <br /> Address! Lice s _.:, _......, .. .. _... _ ....._ ... ^ <br /> License <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 (httpj /appraiser.pascogov.com) <br /> • <br /> • <br />