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813 - 780 -0020 City of Zephyrhifls Fire Fax- 813-780 -0021 <br /> Permit Application <br /> Date Received 1 Phone Contact for Permit <br /> /�� 7 <br /> Owner's Name �9etys' eD Owner's Phone Number �» 7 2 4272 <br /> Owner's Address 6.P& J , // &Lid <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address 1 I <br /> -germ Fawenf m smitz.romi: .n mo ,`a �s .� 'i :- i,s.:., s`. . S "`sr "�Si,�:r M am,°.:v?x' : ka,3?F."skr^.?:<" »�+ .aa: / a x, ' .. � F, u« .<5+. EX �I1 d MUli .ki.w,..s 'MPAVY, .. <br /> Job Address (� `p 6 OGi 6,4% % A L vd Z- �l�. /�6 (� Lot # <br /> Sub Division ddb Parcel # <br /> .cr <br /> n Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> I — I Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> Itltrlyl isemil Other <br /> Sprinkler n ❑ ❑ ❑ 1 1 Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I ( n Sparklers <br /> Hood Cleaning ❑ ❑ ❑ I ( n Sprinkler System Installations <br /> Hood Suppression ❑X ❑ I 1 Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle , <br /> n Fire Pumps I I Waste Tire Storage ANNUAL <br /> I Fire Works <br /> Flammable Application- ANNUAL I ) Valuation of Project <br /> Fuel Tanks <br /> I Other: I <br /> Z"b ..I -, €' E4% a- _�. m &a.:: x .°*ts g ° . .... —,4t4 ,:eu c°' . zuga asmaa "..a a 'w:". , <br /> Contractor e Company �t re. i )Gs .-- <br /> Signature ° Registered Y / N I Fee Current I Y / N <br /> Address I O age If &Ts Lem 0' 4 . 3g 3 /63 It I License # I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N I <br /> Address I I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y N J <br /> Address I ( License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N 1 Fee Current I Y / N <br /> Address I I License # I I <br /> OTHER Company I <br /> Signature Registered Y / N I Fee Current L Y/ N <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 />