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City of.Ze h rhills"Fire Fax- 813-780 -0021 <br /> 81�- 780 -0020 tY p Y <br /> Permit Application - - <br /> Date Received <br /> /1'p2-0 7411 Phone Contact for Permit <br /> r , <br /> Owner's Name ! r 1 1`01\i 61 1 S Owner's Phone Number <br /> Owners Address <br /> Fee Simple Titleholder Name Titleholder Phone Number , <br /> Fee Simple Titleholder Address I I <br /> Z :rcf' , .vac:5 <br /> Job Address 7 � cJ \ ( fL� 8 LA) <br /> ) Lot # <br /> Sub Division Parcel # <br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct I I Hazardous Material (Tier II or RQ Facility) ANJ¢UAL - -" .. <br /> n Controlled Bum n Hood Installation / <br /> En Emergency Generator < 30 kw LP /Nat ural Gas - Installation /? (/" <br /> n : <br /> 1/ <br /> Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL S e � , J / Fire Protection Maintenance - ANNUAL n Places of Assembly -ANNU L r <br /> 1utny1 ) ben I MI Other <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum - <br /> Fire Alarm ❑ ID 1 n Sparklers <br /> Hood Cleaning T 1 ❑ ❑ I 7 Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ l 1 n Standpipes (Sprinkler Sys) <br /> I - 1 Fire Alarrn 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 /> n Other: <br /> Contractor / /�� Company nJ SA 5 ez./ i L <br /> Signature Registered Y / N I Fee Current Y / N <br /> Address 1111111 0 A.,• A, `%r/ 11' r X 6, License # j I <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N I Fee Current 1 Y / N <br /> Address I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current 1 Y / N 1 <br /> Address 1 I License # I <br /> MECHANICAL Company I <br /> Signature Registered _ Y / N 1 Fee Current I Y / N <br /> Address 1 1 License # I <br /> OTHER Company I <br /> Signature Registered Y / N 1 Fee Current I Y / N <br /> Address License # <br /> �. ._. �.�<�,... <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 />