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813 -780 -0020 City ofZephyrhilis'Fire. 4 moil- Fax - 81:_780 -0021 <br /> Permit Application l <br /> Date Received ;cc 0,2 0 / 0 - Phone Contact for Permit <br /> �liYr^SG43fRMV:9YMr°NJiC: : "' •'x.erac�Ora... � - <br /> Owner's Name L /* 2-LO NY/Z. - T� Owner's Phone Number 2/3 5 , 93!/ <br /> Owners Address P. O, 3ZX 0 )71A-9.79- � -L 33671 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address 1 <br /> Job Address nEn L S 0 AI Geet , (Qe /v PtJ9AJL Lot# <br /> Sub Division Parcel # <br /> maximessimastemagetvereir e Nesismassim <br /> n Bio- Hazard Waste Storage --ANNUAL n Fumigation Tent <br /> Ti Comm Exhaust Kitchen Hood /Duct I ( Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw • I 1 LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL I l Places of Assembly- ANNUAL <br /> 1 Utrly 1 I semi I pG9 Other <br /> Sprinkler n ❑ ❑ ❑ I I Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning I// I ❑ c() ( I Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I I l Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation Go LLFN mil/®..f. j-/ n Torch Roofing/Tar Kettle <br /> 7 Fire Pumps HE-AS OA/ U: AV( fl Waste Tire Storage ANNUAL <br /> Fire Works <br /> H Flammable Application- ANNUAL I ( Valuation of Project <br /> Fuel Tanks <br /> Other: <br /> Contractor <br /> ev� / Company �./lVl /7 <br /> �-) l <br /> Signature � `� ' Registered Y / N 1 Fee Current Y / N <br /> Address J I License # l <br /> ELECTRICIAN Company <br /> Signature Registered Y / N 1 Fee Current I Y / N <br /> Address 1 I <br /> l License # <br /> PLUMBER Company I <br /> Signature Registered Y / N I Fee Current I Y / N j <br /> Address 1 License # J <br /> MECHANICAL Company <br /> Signature Registered Y / N ] Fee Current I Y / N <br /> • <br /> Address I I - License # <br /> OTHER • Company <br /> Signature Registered Y / N 1 Fee Current I Y / N <br /> Address 1 1 License # <br /> waszemersieszramesite <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 />