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Apr. 30. 2010 1:33PM A -1 FIRE & ELECTRIC No. 4931 P. 3/4 <br /> 013.780.0020 City of Zephyrhllls Flre Fax -813- 780.0021 <br /> ' Permit Application <br /> Date Received r • , Phone Contact for Permlt l 1 I 1 <br /> Owner's Name r a w be t_........ I Owners Phone Number 1 i j ] `_?� .. <br /> Owner's Address L 313 G-411 6 fv , . • 1 <br /> Fee Simple Titleholder Nome I I. Titleholder Phone Number I 1 1 ( 1 <br /> Fee Simple Titleholder address <br /> Job Address Gall I ` - Lot t/ I l <br /> Sub Division 1 1 Parcel # <br /> E Bio- Hazard Waste Storage • ANNUAL n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> El Comm Exhaust Kitchen Hood/Ducl 7 Hood InstallaUon <br /> 0 Controlled Bum r--1 LP/Natural Gas - Installation <br /> 0 Emergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sete <br /> n Emergency Generator n• 30 kw ED Places or Assembly- ANNUAL <br /> 0 Fire Protection Maintenance- ANNUAL 0 Recreational Burn <br /> au LIM 12E1 =MN <br /> Sprinkler 0 0 0 ❑ NE Sparklers <br /> l <br /> Fire Alarm l 0 0 ❑( I F Sprinkler Syslem Installations <br /> Hood Cleaning [r1 0 ❑ ❑ mi ❑ Standpipes (Sprinkler Sys) <br /> Hood Suppression '❑ i 0 l I El Torch Roofing/Ter Kettle <br /> n Fire Alarm Installation n Wattle Tire Storage ANNUAL <br /> Fire Pumps <br /> ® <br /> Fire Works <br /> H Flammable Application- ANNUAL ( Z.S c O 1 Valuation of Protect <br /> Fuel Tanks -Z <br /> E1 Other: I . <br /> � <br /> Contractor 1 Company A f F; haul 1r7' <br /> Signature Registered N / N Fee Current Y / NN <br /> Address 1 36/9 It 2."r`'#u4 - M•iot n. 71 /2-7 I License # I 0/9 17 ? o o 0 /r 9 (25 I <br /> ■ <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N J Fee Current I Y/ N I <br /> Address I I License # f 1 <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I YON] <br /> Address I I License # L <br /> MECHANICAL Company I <br /> Signature Registered I Y / N I Fee Current 1 Y/ N I <br /> Address I I License ff 1 <br /> OTHER Company I <br /> Signature Registered Y/ N 1 Fee Current I Y/ N I <br /> Address I ( License # I <br /> Directions: <br /> FIII out application completely. <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> IF over 32500, a Notice of Commencement is required (Mechanical work over 35000) <br /> Supply two (2) eels of drawings with applicable documenlallon • <br /> Mow 10 -14 days for review after submittal date, Parcel # - obtained from Property Tax Nolice (http: / /appralser.pascogov.com) <br /> • <br />