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813780 -0020 City of ZephyrhiUs Fire Fax- 813-780 -0021 <br /> Permit Application <br /> Date Received 1 - /7) Phone Contact for Permit <br /> Owner's Name 14)/9 L /4 11 # 2 ©6 Owner's Phone Number 1 $Y3 ( ? P Z / 5 j 7 <br /> Owner's Address ? 6 3/ o4 LC 4 2 C p / /'Y//lz t 1 f( 3 3 s // <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> >_., i ., kl ..fix MIL:la r . l `?': ' r` s. ».S z Igt n Vie, arraftW la4d,,u Mx tir ONOXI :` itl: . : t , c; 4.. . , a B <br /> Job Address 5 4" (- Lot # <br /> Sub Division Parcel # <br /> ..;_." ......c," -,«« IM w . .i:' 4,44 4 " :4X,V 4.W tY.: fi44. 4 :`.. 4 =Aft " ' ar t`.'' . : A . ,N 5 »..„... ,:...ux"". =wM R.,...». , ,.w.: : : is ki.Z.: :,..4 )a ::4 0 V ,, : ;,, a> 4 r k4'0 ;: ;....-a <br /> n Bio- Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier II or RQ Facility } ANNUAL <br /> I Controlled Bum I I Hood Installation / , <br /> I Emergency Generator < 30 kw I I LP /Natural Gas - Installation /� <br /> I Emergency Generator > 30 kw I LP /Natural Gas - ANNUAL SaIe ! Oa f <br /> 04 Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL I v <br /> JSemil fill Uther ` ,' <br /> El . I <br /> Sprinkler ❑ Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ 1 1 I Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I ( Sprinkler System Installations <br /> Hood Suppression I ❑ ❑ ❑ f I Standpipes (Sprinkler Sys) <br /> I I Fire Alarm Installation I Torch Roofing/Tar Kettle <br /> I Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL ( I Valuation of Project <br /> Fuel Tanks <br /> nI Other: I <br /> Contractor <br /> Company <br /> Signature Registered Y / N _ Fee Current I Y / N I <br /> Address I <br /> License # <br /> ELECTRICIAN Company <br /> Signature Registered Y / N I Fee Current I Y / N <br /> Address I <br /> License # <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N _ <br /> Address I <br /> I License # <br /> MECHANICAL Company <br /> Signature Registered Y / N _ Fee Current I Y / N <br /> Address <br /> I License # <br /> OTHER <br /> Company <br /> Signature Registered Y / N . 1 Fee Current I Y / N <br /> Address I <br /> License # <br /> m.. a.. u.+.. ,ue..w:u�cc.:m.kw..ee.a... ,c r'arsecwe:v wse..M.v.,- ,,.ra.:..evu:�.... su :�... .,. a• = ^v' <br /> Directions:; r , . _ I _s <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 />