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813780 -0020 City of:Zephyrhltls Fire a ra < -o i o -r ov <br /> Permit Application 49(1(( G <br /> • Phone Contactfor Permit <br /> Date Receved., <br /> Owner's Name I hL r h 11' S �c-�" 1`-q \ I Owners Phone Number I 1 I 1 1 <br /> _ I <br /> Owners Address 1 `170 C-,c(II 601 , _ 41 (� _� i 17( Name I Titleholder Phone Number I I 1 1 1 I <br /> Fee Simple Titleholder I I <br /> Fee Simple Titleholder Address <br /> ��- O.. c I) . ?Ad - Z t4 <br /> i' I 3 , -L 1 Lot # I <br /> Job Address I l �I <br /> �-l1. �� 1 I <br /> Sub Division I I Parcel # I <br /> 0 Bio- Hazard Waste Storage - ANNUAL = Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> a Controlled Bum I Hood Installation <br /> Emergency Generator < 30 kw El LP /Natural Gas - Installation <br /> Emergency Generator > 30 kw ED LP /Natural Gas - ANNUAL Sale <br /> a Fire Protection Maintenance - ANNUAL E Places of Assembly- ANNUAL <br /> r Iemi Lail Uther <br /> Sprinkler i 0 ❑ E] Recreational Bum <br /> Fire Alarm ED ❑ ❑ ❑ I I = Sparklers <br /> Hood Cleaning Ej ❑ ❑ ❑ I 1 Sprinkler System Installations <br /> Hood Suppression 0 ❑ ❑ ❑ I I = Standpipes (Sprinkler Sys) <br /> ED Fire Alarm Installation a Torch Roofing/Tar Kettle <br /> Fire Pumps Waste Tire Storage ANNUAL <br /> Fire Works I <br /> Flammable Application- ANNUAL Valuation of Project <br /> Fuel Tanks I <br /> Q Other: 1 <br /> Contractor ompany [ 1 T-.),;(0 rr tf -. C.CtrS <br /> Signature � ∎r egistered I Y N Fee Current - Y 1 N <br /> ���t�� .�� <br /> Address � i ir i . License # I ll k Ug7(X Y; I Icri c / 1 <br /> ELECTRICIAN Company <br /> Signature m" Registered Y/ N I Fee Current I Y/ N <br /> e License # I <br /> Address ( � <br /> PLUMBER + 111k -mod.. Company <br /> Signature <br /> ` 'r Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y / N <br /> Address I I License # <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current 1 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 /> • <br />