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813-780-0020 City of Zephyrhilis Fire. 1 - 1 ' Fax-813-780-0021 <br /> Permit Application <br /> Date Received r 6/2_0/01 � � - --7• ._:,•.�,_,_ <br /> PhonA Contact for Permit / <br /> Owner's Name STMPT,F,XGRTNNETJL Owner's Phone Number 813 626 5482 <br /> Owner's Address 4701 Oak Fair Blvd TAMPA FL 33610 . <br /> Fee Simple Titleholder Name • Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address — 7 0 S 0 Ga 1/ Glad Z e yi wkS / F/, 3 3 S y ( Lot # <br /> Sub Division Parcel #� <br /> I Bio- Hazard Waste Storage - ANNUAL I Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier If or RQ Facility) ANNUAL <br /> I . • Controlled Bum I Hood Installation <br /> I Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> I Emergency Generator > 30 kw • I LP /Natural Gas - ANNUAL Sale <br /> I . Fire Protection Maintenance - ANNUAL . • I Places of Assembly- ANNUAL <br /> 'Utrly ! Semi ( (Anl ( Other <br /> Sprinkler. I 1 ❑ ❑ ❑. 1 1 Recreational Burn • <br /> , Fire Alarm I I ❑ ❑ O. I' • 1 1 1 Sparklers <br /> Hood Cleaning X1 o X ❑ I 1 1 Sprinkler System Installations <br /> • Hood Suppression I 1 0 0 0 . I 1 . - 1 - 1 ... Standpipes (Sprinkler Sys), • <br /> Fire Alarm Installation - .. -- <br /> I Torch Roofing/Tar Kettle <br /> - I Fire Pumps I - Waste Tire Storage ANNUAL <br /> I A Fire Works • <br /> I Flammable Application- ANNUAL ! I Valuation of Project <br /> I Fuel Tanks <br /> I Other: I <br /> t( <br /> f v�,mt'S tY <br /> Contractor Company 3 ere -r Kf,viv c. <br /> Signature Registered I Y/ N Fee Current ' Y / N 1 <br /> Address I . . ' I License # ! • • <br /> ELECTRICIAN - Company > <br /> Signature Registered Y / N Fee Current 1 .:Y / N : I <br /> Address <br /> 1 License # I <br /> PLUMBER - ,- . Company w ' <br /> Signature Registered L Y/ N' I Fee Current` I Y 1 N• I . <br /> Address I I License # - I • I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y / N <br /> . Address I • I License # I <br /> OTHER Company . <br /> • <br /> Signature Registered L Y/ N I Fee Current I Y / N I <br /> Address License # I <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 /> . <br /> ' Allow 10 -14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http : / /appraiser.pascogov.com) <br /> • <br />