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813- 780-0020 City of Zephyrhius Fax- 813-780 -0021 <br /> Permit Application . <br /> )ate Received 5 -/—/P I - Ph C <br /> w y�sV P`� Contact for Perm <br /> )wner's Name '}' •*t_ _ , ARAM a a a Z 1). t , Owner's Phone Number Is/ 3 (7eS'4). 1 Is c <br /> )wner's Address 3. 3 i H ► f - e . 7. (' k. its I '3 ' / <br /> :ee Simple Titleholder Name 1 Titleholder Phone Number <br /> =ee Simple Titleholder Address 1 <br /> -.- .. - ✓.. .. .. s .__. :n,,c .,.Y. '...., Ito- .o > - ' -. _ :, ..:' f ,, NEE <br /> Job Address Lot # <br /> Sub Division I I Parcel # 1 <br /> Bb- Hazard Waste Storage - ANNUAL Fumigation Tent <br /> EJ Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> El Controlled Burn n Hood installation <br /> n Emergency Generator < 30 kw <br /> LP /N Gas - installation <br /> E1 Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sal f t <br /> Fire Protection Maintenance - ANNUAL n ��// Places of Assembly -ANN L /r / <br /> •; emi li Vtner rl rr <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum __ , <br /> Are Alarm H ❑ ❑ I 1 n Sparklers <br /> Hood Cleaning ❑ ❑ al f I n Sprinkler System Installations dt <br /> Hood Suppression Ej ❑ ❑ ❑ , I n Standpipes (Sprinkler Sys) <br /> El Are Alarm Installation = Torch Roofing/Tar Kettle <br /> H n Are Pumps <br /> Waste Tire Storage ANNUAL • Fire Works <br /> R FlammableApplication- ANNUAL <br /> F Valuation of Project <br /> Fuel Tanks <br /> n Other: I <br /> Contractor ,/ f Q }. CA-r0-1-11 eS <br /> Signature 4-f;14.---,..4_ Company i ti- 9 Registered / N F Current Y / N <br /> Address I ` ° I N e c ' i • .' t . 33 .. License # E F - (Qt( I 0-1 t p ` <br /> ELECTRICIAN <br /> Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address I License # I <br /> PLUMBER Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address 1 <br /> License # <br /> MECHANICAL Company <br /> Signature Registered Y / N I Fee Current I Y/ N I <br /> Address I I License # <br /> OTHER <br /> Signature <br /> Company <br /> Registered Y / N Fee Current Y / N <br /> Address i <br /> k= - . mow. 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:Uappraiser.pascogov.com) <br />