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City of Ze h Ills Fire Fax - 813- 780 -0021 <br /> 813- 780-0020 4 g i YO tY P Yfi <br /> Permit Application <br /> )ate Received ZZZ <br /> Phone Contact for Permit <br /> _ . «. ;..xea..,r ,m;.'. 't •.z•. x._.s ; ; '? -. K . _t: .....,.x -. .4 ..w arxw.r- <br /> owner's Name V y `,\ y.S Owner's Phone Number ' a 1 ) i ) <br /> )wner's Address <br /> =ee Simple Titleholder Name Titleholder Phone Number ' ) ' ) l 1) <br /> =ere Simple Titleholder Address I <br /> Job Address 5G • • _ k\ V ` LA • 33 HO Lot# 1 <br /> Sub Division Parcel # <br /> n Bio-Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood/Duct I 1 Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> E Controlled Bum I I Hood Installation <br /> Li Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> I Emergency Generator> 30 kw n LP /Natural Gas- ANNUAL Sale <br /> ill Fire Protection Maintenance - ANNUAL l 1 Places of Assembly- ANNUAL <br /> pr d (semi l jai other <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ 1 1 n Sparklers <br /> Hood Cleaning ■ ❑ ❑ ❑ n Spnnkler System installations <br /> Hood Suppression 7 ❑ ❑ ❑ ` I Standpipes (Sprinkler Sys) <br /> 7 Fire Alarm Installation ^ I Torch Roofing/Tar Kettle <br /> , <br /> Fire Pumps 3 1 r"..N I Waste lire Storage ANNUAL <br /> Fire Works <br /> H Flammable Application- ANNUAL Valuation of Project <br /> Fuel Tanks <br /> C Other: I <br /> Contractor 7 Company SoOkAn n F it'Q yS-A-PfT\ <br /> Signature Registered Y ( Fee Current Y / N j <br /> Address LIMO _ Z`' W . Coq Zy" i! License# <br /> ELECTRICIAN Company <br /> Signature Registered Y / N ' Fee Current I Y / N <br /> Address ( I License # I ' <br /> PLUMBER Company <br /> Signature Registered Y/ N f Fee Current l Y/ N <br /> Address I License # I I <br /> MECHANICAL Company <br /> Signature Registered Y / N 1 Fee Current 1 Y/ N <br /> Address I License # I <br /> OTHER Company <br /> Signature Registered YIN ' Fee Current 1 Y / N 1 <br /> Address License # <br /> r wwnxia°a _, :., , .. ...... _. ., s,c;r. �.•vr :_ '.v:c, ... ; .... ;. _�r� -.a: cur . °r.a.as�axu�r� <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 />