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J <br /> 813780 -0020 /` City of Ze h rhills <br /> /y/(0 tY P Y FaX- 813780 -0021 <br /> I/ Permit Application <br /> Date Received I - it Contact for Permit <br /> on <br /> Owner's Name STMPT,FX(;RINNELL Owners Phone Number <br /> 813 626 15482 <br /> Owners Address 4701 Oak Fair Blvd TAMPA FL 33610 <br /> Fee Simple Titleholder Name I - I Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address SISd 0 ` pallkt- -CCU 7—eh ((1+%�j ,TL ` <br /> — 1 3.f) 0 Lot# I <br /> Sub Division <br /> Parcel # <br /> I • I Bio- Hazard Waste Storage - ANNUAL Fumigation Tent <br /> I I Comm Exhaust Kitchen Hood /Duct Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> I . • Controlled Burn Hood Installation <br /> 1 1 Emergency Generator < 30 kw LP /Natural Gas - Installation <br /> _ . I Emergency Generator > 30 kw LP /Natural Gas - ANNUAL Safe <br /> I. I Fire Protection Maintenance - ANNUAL Places of Assembly- ANNUAL y u . 0 <br /> Utrl (Semi' IAnl I Uther /± �!I 1 fl <br /> Sprinkler I I ❑ ' ❑ ❑, - I I Recreational Burn ' <br /> Fire Alarm I ---- ❑ ❑ Fel l Sparklers <br /> Hood Cleaning I 0 ❑ ❑ I I I I Sprinkler' System Install ns i q g <br /> • Hood Suppression 1 I 0 ❑ I I I I (P �Y " o s <br /> ire Alarm Installation n #� <br /> Standpipes S ri kler s V <br /> I F <br /> Torch Roofing/Tar Kettle tip . _ , <br /> Fire Pumps I Waste The Storage ANNUAL <br /> I Fire Works <br /> I Flammable Application- ANNUAL <br /> _ 1 �'�'d.. ua tior�..n€ -eject <br /> I : . <br /> Fuel Tanks <br /> • <br /> I Other: <br /> Contractor - • ����� <br /> Signature 1 3 ' t K - ( f <br /> / Company Registered Y / N J Fee .Current I. Y / N <br /> Address I c� <br /> I . License # <br /> ELECTRICIAN . ... <br /> Signature <br /> . Registered Y / N I Fee Current I . Y / N : I . <br /> Address I I License # I <br /> PLUMBER <br /> Company <br /> Signature Registered Y/ N j Fee Current I Y/ N 1 <br /> Address I I License # . • <br /> MECHANICAL I Company <br /> Signature Registered Y/ N j Fee Current I Y/ N I <br /> Address . <br /> I License # I <br /> OTHER I Company <br /> Signature Registered Y/ N Fee Current I 'MI I <br /> Address License # `` <br /> 1 <br /> �kc . asp <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: / /appraiser.pascogov.com) <br /> • <br />