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T / n 7 2 C f I T! ' i • 2 7 AID. ZEPHYPH I LLS BUILDING \! (' , . ; 4 ._ .. _ :j i <br /> 819780 -0420 , City ofZephyrhilisFine•'• 92/ l'' Fax-813-780-0021 <br /> Permit Application . <br /> Date Received - Phone Contactfor Permit I I . • <br /> Owner's Name I - . Owner's Phone Number . 1 5 ( 3 1 MN OS <br /> Owners Address '5 %. 9 U.I.G Ki . A-r` t <br /> Fee Simple Titleholder Name Titleholder Phone Number , M <br /> Fee. Simple'Titleholder Address <br /> Job Address b (P• . /-! \) •.- Lot # • <br /> Sub Division Parcel # <br /> a ss... r•..., ,... -;. �. •,.. .., , . .:.. .: ....:... -,.. _ -... -- _.:. : -.:.- ..: .. ,::_.. ..,.. .. ..._, ...._. -.. .. .. .. _. -.. _. . <br /> ED Bio- Hazard Waste Storage - ANNUAL ' Fumigation Tent <br /> j] Comm Exhaust Kitchen Hood/Duct Ii . Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum n Hood installation . <br /> III Emergency Generator K 30 kw n LPINaftual Gas Installation <br /> MI Emergency Generator r 30 kw ED LP/Natural Gas - ANNUAL Sale <br /> Uhl Fire. Protection Maintenance - ANNUAL .- - E=j Places of Assembly- ANNUAL <br /> J r y rErrel lai tither • <br /> • Sprinkler ED ❑ 17 0 . . El Recreational Bum <br /> Fire Alarm Q C D 1 I El sere <br /> Hood Cleaning ❑ ❑ ❑ ❑ I I • El Sprinkler System Installations. , <br /> Hood Suppression ❑ .0 ❑ . - Q Stendplpes.(Sprinkier Sys) <br /> Fire Alarm Installation ` Torch Roofing/Tar Kettle <br /> n Fire Pumps - hi Waste Tire Storage ANNUAL . <br /> . <br /> Fire Works <br /> Flammable Application- ANNUAL . 1 --".-- Valuation of Project <br /> Fuel Tanks <br /> n Other. <br /> Contractor �` iAr <br /> T Company III <br /> Signature _ ` S a 5 - ' aegistered MIMI Fee Current • MEI <br /> - <br /> Addresa S l' —c— ` S �-e— _ S License # <br /> ELECTRICIAN • Company j <br /> Signature Registered Y/ N r Fee Current 1 Y / N j <br /> Address L license # <br /> PLUMBt=R .Company • i I . <br /> Signature Registered Y / N Fee Current • I Y / NJ . • Address , . License #. I ' <br /> MECHANICAL - Company <br /> Signature Registered Y/ N J Fee Current j Y/ NI <br /> Address L 1 • License # I 1 <br /> OTHER - Company <br /> • <br /> Si • Registered Y / N. Fee Current j Y / N 1 <br /> Address . ' License d# ,. <br /> Direction: <br /> Fill out application oompletely. <br /> Owner & Contractor sigh back of application, notarized (Or, copy of signed contract with owner) <br /> If over $2500, a Notice of Commencement Is required,(Meohanlcal work over 550 <br /> Supply two (2) sets of drawings with applicable documentation <br /> Allow 1D-14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http:/ /appraiaer.paseogov.com) <br /> • • • <br /> . <br />