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' 813- 780-0020 City of ZephyrhillS Fire.. Fax- 813 - 78040021 <br /> Permit Application <br /> late Received IA «iMIIIII <br /> - Phone C Permit • Contact for MAW <br /> 5 <br /> )wner's Name I Owner's Phone Number 5( — ' <br /> ) wner's Address 9 30 /S � S 1 2e104 r , f ' F1 33_5-4/,), <br /> =ee Simple Titleholder Name I Titleholder Phone Number I I I <br /> =ee Simple Titleholder Address I ` <br /> Job Address ei3d S J iI .5 1 Ze r i,, ',//5 } F j 3 SL�.)-�' Lot # <br /> Sub Division <br /> Parcel # I <br /> n Bio - Hazard Waste Storage - ANNUAL Q Fumigation Tent <br /> ED Comm Exhaust Kitchen Hood/Duct n <br /> .Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I - 1 Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation ti '''''.. <br /> Emergency Generator> 30 kw I ( LP /Natural Gas - ANNUAL le Fire Protection Maintenance - ANNUAL o Places of Assembly -AN AL /r/ <br /> ® ® ®W'� <br /> / Sprinkler n' r - I n l. Recreatlonai Bum 4 <br /> Fire Alarm ❑ I Spanners /t ly , 1 I [ <br /> Hood Cleaning E3 ID ID CD I El Sprinkler s <br /> ler System Installations <br /> Hood Suppression 0 ❑ ❑ ❑ I 1 n Standpipes (Sprinkler Sys) <br /> ED Fire Alarm Installation n Torch RoofingfTar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL <br /> Valuation of Project <br /> Fuel Tanks <br /> n Other, I <br /> Contractor Company I � - 1i I <br /> Signature /73 `7 <br /> Registered / N Fee Current Y / N <br /> Address I %9 /y ffCe., /iy ?/6 Z.4-- I License# 5i o /0y6 I <br /> ELECTRICIAN <br /> Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address <br /> I License # <br /> PLUMBER Company <br /> Signature <br /> Registered Y / N Fee Current Y / N <br /> Address I <br /> I License # <br /> 1 <br /> MECHANICAL Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address I I License # I <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y 1 N j <br /> Address I t <br /> =� . ,�1 License # I <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: /lappraiser.pascogov.com) <br />