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813-780-0020 City of ZephyrhillsFiree 4 ( 1 Fax - 813 -780 -0021 <br /> Permit Application <br /> Date Received . - Phone Contact for Permit <br /> Owner's Name S TMPT,F;XGR_TNNELL Owners Phone Number 813 626 5 4 8 2 <br /> Owners Address 4701 Oak Fair Blvd TAMPA FL 33610 . <br /> Fee Simple Titleholder Name • ' Titleholder Phone Number <br /> Fee Simple Titleholder Address I . <br /> ��"',`.�'�•_ - .azrs# - ,�.. r..,_ -:�' ...._. �_,,:�':° �`�- ._- a,.�"�. sue,- Sa.,`;'`."e:.'�-�'�;".��,� _ __ .,,�..,.. :� � r� ��.�,"' �''r _:'-�" ��� <br /> Job Address 3 2.5o A- pee_ • ZePt,vrhols -1-1_ 335-0 Lot# <br /> Sub Division Parcel # <br /> I Bio- Hazard Waste Storage - ANNUAL Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I Controlled Bum Hood Installation <br /> I Emergency Generator < 30 kw LP /Natural Gas - Installation <br /> , I.. 1 Emergency Generator > 30 kw LP /Natural Gas - ANNUAL Sale <br /> I . I' Fire Protection Maintenance - ANNUAL - Places of Assembly - ANNUAL <br /> Lm JSemr I IAN), Other - <br /> Sprinkler. aw ❑ ❑ V - f ( Recreational Burn • <br /> Fire Alarm I ❑ ❑ ❑ I 1 I I Sparklers <br /> Hood Cleaning I I 0 ❑ ❑ I 1 I I Sprinkler System Installations <br /> • Hood Suppression I I 0 ❑ 0 _ I I _ I I Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation { ( Torch Roofing/Tar Kettle - - <br /> I I Fire Pumps I , Waste Tire Storage ANNUAL <br /> I I • Fire Works <br /> Flammable Application- ANNUAL 1 I Valuation of Project <br /> IL Fuel Tanks • <br /> Other I s•,„inwt,,,, 6acic-(r1 0w <br /> Contractor ilr 41Ir Company -. ( Kt�n •-ti (-( <br /> Signature Registered Y / N J Fee Current I. Y /N I <br /> Address I I . . License # - • I <br /> ELECTRICIAN Company . • <br /> Signature Registered Y/ N Fee Current I :: / N > I . <br /> Address I .. - I License # I <br /> PLUMBER Company ss; <br /> - <br /> Signature Registered Y / N `I Fee Current' I Y / N I <br /> Address I I License # . - I <br /> MECHANICAL Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N <br /> . Address L, - I License # I <br /> OTHER • - Company - <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> mmos 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 />