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8 -780 -0020 City of ZephyrhillS Fire Fax -813 -780 -0021 <br /> Permit Application <br /> Date Received U <br /> -) Q Phone Contact for Permit J <br /> Owner's Name N PC-, j I■3 Owner's Phone Number B "7 Q)g <br /> Tj / 7Ly� <br /> �? <br /> Owner's Address (05q C.A-1) B\ V ei z- Q� yr ls t" L -7) (47 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> ,,,, r. .MW.r ., Z.. nlK+to', rmK i <br /> Job Address g / CA/A .b/ £4 / Z � T j7-1 Lot # <br /> Sub Division Parcel # <br /> , =.,IV ��..,_�� 0.4* . W. ^ Rs �� � Mai a: ° � m <br /> ._. .,� �..� � E..�...',� - - - -:. �;�a:!�.�2_.,,.'rw".� .�z.€' �=��:asc� : ..: .:.�'���.� ° a.:= ae. .a.4�z;.�,�.m�';,_a.£awi�xd;. <br /> 71 Bio -Hazard Waste Storage - ANNUAL r----1 Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> I — I Emergency Generator < 30 kw I—I LP /Natural Gas - Installation <br /> FT Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale " . <br /> El Fire Protection Maintenance - ANNUAL I XI Places of Assembly -ANNU ii 49, 4 <br /> PM' (Semil tither 5 � <br /> Sprinkler JJ ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning I ❑ ❑ ❑ I I 7 Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I I I Standpipes (Sprinkler Sys) <br /> I — I Fire Alarm Installation ri Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> I I Fire Works <br /> Flammable Application- ANNUAL <br /> 1 ( Valuation of Project <br /> pi Fuel Tanks <br /> I—I Other: I <br /> Contractor � / Company (',.ems C...!,19- l f }?g (-- I <br /> Signature <br /> e <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I <br /> I License # I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N j Fee Current I Y/ N I <br /> Address <br /> License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N j Fee Current I Y/ N I <br /> Address I <br /> I License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N j Fee Current I Y / N j <br /> Address I I License # ( <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I License # <br /> I '."x'str <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 />