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, 813-780-0020 ,__, 0 City of ZephyrhillS-Fire. Fax - 813- 780 -0021 <br /> 7 Permit Application <br /> Date Received Phone Contact for Permit <br /> Owner's Name S T MPT,.EXGR I NNELL Owners Phone Number 813 626 5 4 8 2 <br /> Owners Address 4701 Oak Fair Blvd TAMPA FL 33610 <br /> Fee Simple Titleholder Name - Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> kftlifingairailner > 5-- .v tais °r ,, >,s s nk . s . s N.:ms ' x '.;h ; '.: . - av <br /> F <br /> Job Address 1 ` ,�0 - ` Da 0(Y C - 2,e,Potivias c ( S sip Lot # <br /> Sub Division Parcel # <br /> " ,,......+? •.5 ::. r,:oe :'6' '-C .:aa?-;-" 'Y,i. ..,. a,.°s.. Z/W,::4 ",, -, :,,,,,• ..: e# ,A .a�,...,-,1 Y,M ^:.`, " :s�5,�:, ;, '` <br /> Bio- Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum I I Hood Installation <br /> I Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> I Emergency Generator > 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> I Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL <br /> IUtrnyi ISemlI !An! I Other c� <br /> Sprinkler I ( ❑ ❑ ❑ I I Recreational Bum <br /> Fire Alarm I v ❑ ❑ IR I I I I Sparklers 4-1--------1 q <br /> Hood Cleaning n ❑ ❑ ❑ I I n Sprinkler System Installation <br /> Hood Suppression I I ❑ ❑ ❑ I I I I Standpipes (Sprinkler Sys) .. <br /> n Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> Fire Pumps I I Waste Tire Storage ANNUAL <br /> Fire Works <br /> I I Flammable Application- ANNUAL <br /> 1 ) Valuation of Project <br /> i I Fuel Tanks <br /> In Other: I I <br /> Contractor / Company .3 C c Rv ... -c. l✓( I <br /> Signature - Registered Y / N Fee Current I' Y / N I <br /> Address I License # <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address 1 I License # <br /> PLUMBER Company I <br /> Signature Registered ¥ / N' I Fee Current I Y/ N I <br /> Address I I License # , I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current I Y / N <br /> Address I I License # I <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address 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 /> • <br />