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813-780-0020 City ofZephyrhiilsFire• Fax - 813 -780 -0021 <br /> Permit Application <br /> Date (4,-9.11-0.1 Received ... Phone <br /> Contact for rm.. <br /> it <br /> Owner's Name Ilk 1 ( S l( 1 (P T 5-LE'2. . Owner's Phone Number , <br /> Owner's Address <br /> Fee Simple Titleholder Name J I Titleholder Phone Number - <br /> • <br /> Fee SimpleTitlehoider Address ��� ^ { ^' a, .,r <br /> y. Y i g '` gnmvio .wAR..z..: e.� .,;..1.4.••.;•:• . .x / u :.':v,.x a. .ry l ,,,, —: . #e' ... .. v.. . ...., .w .. .. <br /> .:. ,. ..w' t i .I 02 �` €.:3"4. YfEd : <br /> ,.. i� .. , ..a... m'. . , . . �.. x, u... „.. .,. •....v.... v,uw 3 <br /> Job Address <br /> (e 0 3 0 Gl/I G1'ok • . Lot # <br /> Sub Division 1 1 Parcel # N p . = a ,., •.�zfr �� _ <br /> 1 Bio-Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> Comm Exhaust Kitchen Hood/Duct 1 Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n - Controlled Burn 1 1 Hood Installation <br /> Emergency Generator < 30 kw 1 1 LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL 1 ( Places of Assembly- ANNUAL <br /> Hwy] lsemi1 on miaml <br /> Sprinkler n ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm ❑ ❑ a' I I Sparklers <br /> Hood Cleaning n ❑ 0 ❑ I Sprinkler System Installations <br /> Hood Suppression C ❑ ❑ ❑ 1 1 I Standpipes (Sprinkler Sys) <br /> • <br /> Fire Alarm Installation 1' I Torch Rooting/Tar Kettle <br /> Fire Pumps 1 1 Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL M ( Valuation of Project <br /> , 1 Fuel Tanks <br /> 1 1 Other: 1 �.. <br /> Contractor ' �'�(�Gb�1 Company . ' SdCI cuvre S s s <br /> Signature 0 � ) 0 . ' Gi`^ (G Registered Y / N Fee Current Y / N <br /> Address 1 1 License # 1 ( <br /> • <br /> ELECTRICIAN Company <br /> Signature Registered Y / N Fee Current 1 Y / N J <br /> Address License # <br /> PLUMBER Company <br /> Signature Registered Y / N Fee Current - Y / N <br /> Address 1 1 License # 1 <br /> MECHANICAL Company <br /> Signature Registered Y / N Fee Current 1 Y / N <br /> Address 1 •License# <br /> OTHER, Company <br /> Signature Registered Y / N Fee Current 1 Y / N <br /> Address License # <br /> rr"�.")&iTS iel rw,...m,,,,,, —, <br /> Directions: <br /> Fit 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 />