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813-780-0020 City of Zephyrbilts Fire' Fax- 813780 -0021 <br /> Permit Application <br /> Date Received l I Phone Contact for Perrnit ef 195'6, 6 e/bi <br /> Owners Phone Number <br /> Owners Name <br /> Owners Address <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address V /cte-N Ta ",'."-'- '7,Xif la t 335747- Lot# <br /> • <br /> Sub Division 1 / f Parcel # <br /> Bio -Hazard Waste Storage - ANNUAL El Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw El LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL 9 <br /> , UtnyI (Semi) Lai tither <br /> Sprinkler n ❑ ❑ ❑ I n Recreational Bum `,, <br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers (� "i4q <br /> Hood Cleaning 0 ❑ ❑ ❑ I 1 n Sprinkler System Installations I (/'( `r <br /> Hood Suppression (- 7 ❑ z( ❑ I 1 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 /> n Flammable Application- ANNUAL I ( Valuation of Project <br /> n Fuel Tanks <br /> n Other <br /> Contractor �i Company Fi - -)'h - / - - - (/// 4 .* I <br /> Signature % :90"m� Registered Y / N I Fee Current I Y / N <br /> Address I PO 13Ox 6 Gc--, r d• L.„(4 5 ' 3y6 3 f I - . License # ( <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I <br /> PLUMBER Company I <br /> Signature Registered Y / N I Fee Current Y / N I <br /> Address I I License # I I <br /> MECHANICAL Company I <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I I License # I I <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address 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 (http: / /appraiser.pascogov.com) <br />