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813a80 -0020 City of Zephyrhilis Fite. Fax- 813-780-0021 <br /> � <br /> J Permit Application <br /> Date Received v ! l — I ° ° , <br /> �, J U` J Phone Contact for Permit <br /> Owners Name 1 / Le • "1' (jA.IE �aiiv 7. 1 Owners Phone Number 1,14 3 I I 'S 1 I s j 3 <br /> Owners Address 1 S Y,F 4A, Le-- vA Ze 1:0 %% /4 1 <br /> - <br /> Fee Simple Titleholder Name Titleholder Phone Number I 1 1 I <br /> Fee Simple Titleholder Address <br /> .v...� 3 e u�'9+ ,,,nm�'ix a ,.d....rl... <br /> Job Address 1 Lot # I <br /> Sub Division I I Parcel # I <br /> 11 Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> Q Comm Exhaust Kitchen Hood/Duct = Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> I1 Controlled Bum I Hood Installation <br /> Emergency Generator < 30 kw I LP/Natural Gas - Installation / i <br /> I-1 Emergency Generator > 30 kw I LP/Nat rat Gas-ANNUAL ` 1 vvv <br /> n <br /> El Fire Protection Maintenance - ANNUAL n Places of Assembly - ANNUAL 1 V f �" R 1 MI LLLIII <br /> Sprinkler Lj ❑ ❑ ❑ I Recreational Burn ( _______...... <br /> Fire Alarm ❑ ❑ ❑ I I Q sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I I I Sprinkler System installations <br /> . Hood Suppression ® ❑ �[ ❑ I I 17 Standpipes (Sprinkler Sys) <br /> Ii Fire Alarm Installation , ` I Torch Roofing/Tar Kettle <br /> • Fire Pumps I] Waste Tire Storage ANNUAL <br /> Are Works <br /> Flammable Application - ANNUAL I I Valuation of Project <br /> Fuel Tanks <br /> Q Other I <br /> ,m........o..�..<..... -� ..- v...F.=r... .... -�.5 v �.n. - _:.EZS....,"? . .. :.... _:.' �w �;.. • s..:.:. is-6 r :�'r� +-� .. _ 3S'� _— ,i_nesuru...... ' zu � � "�<� �...L,..Y a �..:� > a _':'"&.": <br /> Contractor Company 1 <br /> Signature Registered Y/ N I Fee Current 1 YIN] 1 <br /> Address I I - License # I I <br /> ELECTRICIAN' Company I <br /> Signature 11 Registered Y/ N I Fee Current I Y/ N 1 <br /> Addiess I I License # <br /> PLUMBER Company I <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 J Fee Current 1 Y/ N <br /> Address I 1 License # I I <br /> OTHER ComPanY ��' ��i • i i 4 � J L I <br /> Signature a ^GG GGt.s.„._ <br /> Registered Fee Current <br /> Address s.1.9 s_s License # 066 <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 (httpi/appraiser.pascogov.com) <br />