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813- 780 -0020 City of Zephyrhitis Fire Fax- 813-780 -0021 <br /> Permit Application <br /> Date Received I 2 - i. y cc/ Phone Contact for Permit <br /> ,(Owner's Name 1/ nin -ft S 'TJ2E5 I NC Owner's Phone Number 1 4179 I I S iL I { I 9993 <br /> Owner's Address it 0S S& S SI &n ,U r/ v ((G , i-& 72 7i6' <br /> Fee Simple Titleholder Name Titleholder Phone Number I I I I I ( <br /> Fee Simple Titleholder Address <br /> ,.,. u a2iett:a';, „ .. : ,n fi nx :t. 7 3F ;lte,? SDttMe T , IMZtP °r t VafxMC:r `T ttt. ..- ,.., . tt Ha ". , _ <br /> r <br /> ii >.x d`HM;a.;�,.`c.: <br /> /Job Address 7 � 2j I GALL 81-0) Z EI)Nygo " Lc S r rt. .335tfD ,s. » <br /> Lot # <br /> Sub Division Parcel # <br /> t,.'u ..., ?sf ,A- ., x aur,... c a'1."u`„u..i iP,; ?a':» n'`""£ E.' Gr @iidtfew:i;a.":umrai'ws-.,�u """, aa...,.;.,'" s�". a,*..„; w" r.i, ziha^.m <br /> Bio- Hazard Waste Storage - ANNUAL I Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct I I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum I Hood Installation <br /> Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL I I Place of Assembly -ANNUA . <br /> ILItrly) }Semi' IAN Other / <br /> Sprinkler n ID El I Recreational Bum / / D 1(1 <br /> Fire Alarm I 7I ❑ ❑ ( I Sparklers <br /> Hood Cleaning 7 ID El I Sprinkler System Installatio -------- ...... <br /> Hood Suppression I ❑ ❑ ❑ I Standpipes (Sprinkler Sys) <br /> Ti Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> I Fire Pumps I I Waste Tire Storage ANNUAL <br /> I Fire Works <br /> H Flammable Application- ANNUAL l I Valuation of Project <br /> Fuel Tanks <br /> I Other: I <br /> • ...2.�r " ,r.. °�a:_:k��u ,v»:, :.'kw , .a:?is:,."�+'' 4 '"q..Sr:,.l: cb'z•.a'Y' ": � ..�i;xxt.<.um;.�u5x :.e.,e:;xa`� `?.�.,..:a',�.8:� '� R,. ism ..., .sz:�:,�.v.w�?�a`�C�:s�:;= <br /> Contractor / <br /> �/ Company tact/owe/ -f SYsiVJ /NC . <br /> Signature 'y " �li �(� y /ie Registered N F Current <br /> CO I Y / N <br /> Address I I License # I <br /> ELECTRICIAN Company <br /> Signature Registered Y / N Fee Current I Y / N j <br /> Address I <br /> 1 License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N 1 Fee Current I Y / N <br /> Address I I License # <br /> MECHANICAL Company <br /> Signature Registered Y / N Fee Current I Y/ N j <br /> Address I <br /> I License # I <br /> OTHER Company <br /> Signature Registered Y/ N j Fee Current I Y/ N I <br /> Address I <br /> License # <br /> Directions: r ,: .�, n � - - - j c �� <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 />