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813 -780 -0020 City of Zephyrhifls Fire ' ' : Fax- 813-780 -0021 <br /> "' Permit Application <br /> Date Received - 1 - <br /> Phone Contact for Permit <br /> . w IxkeG�f¢WexWLeNYN3Rixs: ' .,k.• , af, :� .., a x:, .� •_ -." a -. -,: ,n ✓ ".f�. .H. �.x �..+v xs4 <br /> '.. ,, // - �.c <br /> Owner's Name �J /.t/A4S Aftri /e f+F m e — rA444, Owner's Phone Number 1 194 cZ 1/4,41 - <br /> Owners Address &Pe:N.7.2 w /n/X.,e 1),,ei✓ e. Z. a4i - d/S /cL. <br /> Fee SimpleTitleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address Lot # <br /> Sub Division Parcel # <br /> Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> El 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 /> JUtny) LSemi1 j other <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I n Sparklers <br /> Hood Cleaning ❑ ., ❑ 1 1 n Sprinkler System Installations <br /> Hood Suppression ❑ AI ❑ ( I n Standpipes (Sprinkler Sys) <br /> El Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> 0 Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL I I Valuation of Project <br /> Fuel Tanks <br /> F Other <br /> . .� .. Mu^_.. `:: =?%a it , .x ,w_ ':'z.tr' €4 - .s'wvq.: -+a.. . A', ;::::YS ia'- U:4'tirn... iraa'+C'.'r.'3Fd':s¢F 'S* "a+.s 'i✓dd;SSS+ttLi_, .+,e'.x: tl_Ni4?aSi. ^,:'Ki:$f *s:. <br /> Contractor Company I <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address 1 I License # <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N 1 Fee Current 1 Y/ N I <br /> Address I I License # <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N j <br /> Address I I License # <br /> MECHANICAL Company I <br /> Signature - Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # <br /> OTHER Company pp I/ .44Pe Eau. 7" �CGC' <br /> Signature Registered N 1 Fee Current N <br /> Address License # ‘ O • , / G Oe <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 (httpJ /appraiser.pascogov.com) <br />