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. 313-780 -0020 City ofZephyrhilis'Fire :.. Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received 31 - 20/4 Phone Contact for Permit 1 <br /> Owner's Name �f "iia„ Ate } t:,4__ fj 10., o,, r7peiy 7.4 G. — . <br /> Owner's Phone Number I , G 75- j <br /> Owner's Address % ' nI • .5c , %c NGaj /X MJQAR S / Z . �'$�, �' " <br /> Fee Simple Titleholder Name Titleholder. Phone Number J <br /> Fee Simple 'Titleholder Address I <br /> Job Address AO, , fi t= Lot# <br /> Sub Division Parcel # <br /> n Bio-Hazard Waste Storage --ANNUAL n Fumigation Tent • <br /> Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Burn n Hood Installation <br /> • n Emergency Generator < 30 kw n LP /Natural Gas - installation <br /> n Emergency Generator> 30•kw n LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL Places of Assembly- ANNUAL <br /> r y' emi ®' gam / (� 5 l <br /> Sprinkler n ❑ DI . ID ® n Recreational Bum <br /> Fire Alarm Ea ❑ ❑ r I I Sparklers - <br /> Hood Cleaning n ❑ ❑ ❑ I I I I Sprinklersystem Installations <br /> Hood Suppression = ❑ ❑ ❑ .) I n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> M Fire Pumps ' n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL ( Valuation of Project <br /> Fuel Tanks <br /> in other: l <br /> Contractor / Company � +1:--42- f} )cir•- CO »,/ <br /> Signature rl� f - . Registered Y /.N 1 Fee Current /Y / N 1 <br /> Address 1 I License # EFt, ov/dd L <br /> ELECTRICIAN Company . <br /> Signature Registered Y / N j Fee Current Y / N I <br /> Address 1 I License* 1 I <br /> PLUMBER Company <br /> Signature Registered Y / N Fee Current I Y / N <br /> Address 1 I License # <br /> MECHANICAL • Company <br /> Signature Registered Y N j F ee Current Y N <br /> Address I I • License # I I <br /> OTHER Company <br /> Signature Registered Y / N Fee Current I Y / N _ <br /> Address License # <br /> .�.:. W., , • -nom <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 submtttal date. Parcel # - obtained from Property Tax Notice (httpl /appraiser.pascogov.com) <br /> • <br /> • <br />