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813-780 -0020 City of ZephyrhillS'Fire Fax -813 -780 -0021
<br /> Permit Application
<br /> Date Received 11F7AU"" Phone Contact for Permit
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<br /> Owner's Name /: / ✓e-._ C e 5 I Owner's Phone Number I 1 I
<br /> Owner's Address ` T5 3,ir- CG / ` 4 6 f (_2.1
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address
<br /> I
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<br /> Job Address .2J 3 /7 (� / / ,Jt ) �J� 2_ 4if�if-ri7� Lot #
<br /> Sub Division �' Parcel #
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<br /> n Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent
<br /> ® Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier 1I or RQ Facility) ANNUAL
<br /> n Controlled Bum 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 /> El Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> r y emi raj tither
<br /> Sprinkler IT ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm 0 ❑ ❑ ❑ 1 1 1 1 Sparklers
<br /> Hood Cleaning „E- ❑ I ( n Sprinkler System Installations
<br /> Hood Suppression El ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> n Fire Pumps n Waste Tire Storage ANNUAL
<br /> n Fire Works
<br /> Flammable Application- ANNUAL I I Valuation of Project
<br /> Fuel Tanks
<br /> Q Other:
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<br /> Contractor � �! Company -� " - di. " A° tJ '
<br /> Signature � . Registered / N Fee Curre t Y / N ,—fi,
<br /> Address c5 1 ; f , /.�/ /� , T - ,,,,e 1 h G�C , ! / License #
<br /> ELECTRICIAN Company
<br /> Signature Registered Y/ N I Fee Current 1 Y/ N
<br /> Address ( I License #
<br /> PLUMBER Company
<br /> Signature Registered Y/ N I Fee Current I Y / N I
<br /> Address I I License # I
<br /> MECHANICAL Company
<br /> Signature Registered Y / N _I Fee Current I Y / N
<br /> Address 1 I License #
<br /> OTHER Company
<br /> Signature Registered Y/ N _I Fee Current 1 Y/ N 1
<br /> Address
<br /> 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: / /appraiser.pascogov.com)
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