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813- 780 -0020 City of Zephyrhilis Fire Fax - 813 - 780 -0021 <br /> Permit Application <br /> Date Received 1 e Contact ontact for Permit I <br /> Owner's Name (/ N cl.&a x a C r` '2.2 a Owners Phone Number 9 L3 82 oiG6 <br /> Owners Address v <br /> Fee Simple Titleholder Name . Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> ,3..,., ,,. ,k M. « . . s ,... T 1 FAN.:. PT r`ORMI£; RMARMA M ..., .MT \ ? . R Lek,?' :affli a;, »,. M ?a.«., . o « akti sA ,z Ko ,�, <br /> ( kb Address___.. 17.'31 63. G �\JA 7 Q yt' `CAN \\S / A 0 Lot# <br /> Sub Division Parcel # <br /> U, ` m ,..r. .: R ,z .:.W»; ...4 :MO €E; naW41=. € , EEY"„°z«`i e,,AWA M. W, a.. > ;.. d .....a.a a <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 /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> I LItrlyl I Semi I Other ; � q <br /> Sprinkler n ❑ CI n Recreational Bum j O O <br /> Fire Alarm ❑ ❑ ❑ I I n Sparklers 1 <br /> Hood Cleaning ❑ X ❑ I I n Sprinkler System Installs • s ' <br /> Hood Suppression ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> I I Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> El Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> 7 Flammable Application- ANNUAL / <br /> 1 I Valuation of Project <br /> E Fuel Tanks <br /> n Other: i I <br /> :&il...+..ti € magge ... ..._:affa_lc.c,e zv. :a ... iaili n aa'� 4 wa,t& , „re ..r e..:SS+.'a �' n� €..a.,a az_K, E, ... _.. <br /> a : .�.._., x.. ...��,.._�.'e:�u.,_ _. ,sue ...€aaxv b:�a..�, d...r.«� 4.,. V....._:.. �.. ...o .,,;iau <br /> Contractor �• r Company (�qS� \ � Y) LL. <br /> Signature L c Q \K') �.Jci t, / Registered Y / N Fee Curren I <br /> Address I _ 1 I License # I <br /> ELECTRICIAN Company <br /> Signature Registered Y / N 1 Fee Current Y / N I <br /> Address I I License # I <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current Y / N I <br /> Address I I License # <br /> MECHANICAL' Company I <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I I License # I I <br /> OTHER Company <br /> Signature Registered Y/ N Fee Current I Y/ N I <br /> Address ( I 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 />