Laserfiche WebLink
81'3 -1$SZ OOZO City Of ZePhyrhillS •Fire- f 1 V t PA Fez-813-780-0021 <br /> Application - _ -- <br /> Phone Contact Permit Date Received <br /> . <br /> e.ct:.. 1 Owners Phone Number � s$ 1 `2Ls 1 <br /> Owners Name : ■t.+2A --� <br /> Owner's Address 1 1 I I 11 <br /> f 1 - fiteholder Phone Number Fee Simple Titleholder Nine <br /> Fee SimpleTitleholderAddress I <br /> W <br /> 1 Lot# l <br /> Job Address 1 1 <br /> Parcel # 1 <br /> Sub Division <br /> INIONNUMMINIAMMIM <br /> E3 Bio- Hazard Waste Storage - ANNUAL ED Fumigation Tent <br /> CI Comn Exhaust Kitchen Hood/Duct a Hazardous Materiel (Tier II or RQ Facility) ANNUAL <br /> 0 Controlled Bum 10 Hood Installation <br /> Emergency Generator < 30 kw n LP!Natual Gas <br /> ED Emergency Generator > 30 kw a LP/Natural Gas ANNUAL Sale <br /> ED Fire Protection Maintenance - ANNUAL ®® = Places of Assembly-ANNUAL <br /> sprinkler o o❑❑ I 1 n Recreational Burn <br /> Are Alarm ❑ ❑ ❑ ❑ I I Spas <br /> Hood Cleaning ❑ ?If. ❑ I I n A SP System Installations <br /> Hood Suppression LJ ❑ ❑ ❑ 1 1 Standpipes (Sprirlder Sys) <br /> ED Fire Alarm Installation a Torch Roofing/Tar Kettle <br /> Fire Phmps a Was The Storage ANNUAL <br /> Fire Works I I Valuation of Project <br /> Flammable Applicalan- ANNUAL <br /> Fuel Tanks I <br /> III a' `. ( ComanY <br /> corhaacmr r —` f S IA ,, Y/ N I Fee Current I Y/ N <br /> Signature , _ O <br /> Address IIIIIIIIIrX L — _ � : ♦_ A . 'License# <br /> ELECTRICIAN 1 Company I <br /> Signature Registered I Y/ N I Fee Currant I Y/ N I <br /> Address I License */ I <br /> Signal re I I Rimed l Y/ N I Fee Current I Y/ N I <br /> Signature I <br /> Address I I License # I <br /> MECHANICAL I <br /> Comps y <br /> I I Registered Y/ N I Fee Current I Y/ N I <br /> Signature I License # I <br /> Address I I <br /> OTHER I Registered I Y/ N I Fee Current I Y/ N 1 <br /> Signature I License # <br /> Address <br /> Directions: <br /> Flt out Contractor completely. <br /> & Com <br /> Owner & ractor sign back of application. notarized (Or, copy of signed contract with owner) <br /> If over $2500, a Notice of Comment is required .(Mechanical work over 55000) <br /> Supply two (2) sets of drawings with appRCabie documentation Tax Notice {ihttpJfappraiser pascogov.ccrmh) <br /> Allow 10-14 days for review after submittal date. Parcel * - obtained from Property <br />