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813 -780 -0020 City of Zephyrhlls Fire Fax- 813 -780 -0021 <br /> Permit Application <br /> Date Receiv 1 Phone Contact for Permit 171:b a '' D <br /> 3 rK� <br /> Owner's Name Ze C I Owner's Phone Number 1 8/3 I 133 Meal <br /> Owner's Address I 3 CPt. 9 Met G F . Qm /1 l) 334 i 8 ao F Jca0,6 <br /> Fee Simple Titleholder Name I I Titleholder Phone Number I I I <br /> Fee Simple Titleholder Address I <br /> •.'..pv•g.. ,7;:;•va v..sr 3—. _ -,,gig wm . , s° x ,,,4 .m , r,_, mromt ,it roFym ,,.o ' m„ Z% .$';,..; .' ',"`�. po �." . = '3'1,41.4 ..„ . a . k"Ew OKTMASk <br /> Job Address 174a0 9a,`/ 6/Vd 7Q ph -A, 1); FL 3397/ / Lot # I / y <br /> Sub Division I Parcel # I36-as -.2 / • 4' 3o- (app -6/ T b <br /> ... . _, .a�eu ¢E$.OI:1 , . ? xW 4: :,,,,Vr4, rs ' „W J- K�a,1 ;.,:: -... ,F . i=s s F E,Siti_ :Q0EM ;: .....:..-ea.. ,x ...fps f3ralaWA .,.?„ WS:: <br /> n Bio- Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Comm Exhaust Kitchen Hood /Duct n Hood Installation <br /> n Controlled Burn n LP /Natural Gas - Installation <br /> p n Emergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale <br /> Emergency Generator > 30 k n Places of Assembly- ANNUAL <br /> Fire Protection Maintenance - ANNUAL n Recreational Burn <br /> IQtrlyI (Semi) WO Other <br /> Sprinkler 0 ❑ ❑ ❑ n Sparklers <br /> Fire Alarm [1 ❑ ❑ ( l n Sprinkler System Installations <br /> Hood Cleaning n ❑ ❑ ❑ I 1 n Standpipes (Sprinkler Sys) <br /> Hood Suppression n ❑ ❑ ❑ I I n Torch Roofing/Tar Kettle <br /> n Fire Alarm Installation n Waste Tire Storage ANNUAL <br /> n Fire Pumps <br /> n Fire Works <br /> Flammable Application- ANNUAL I I Valuation of Project <br /> ri Fuel Tanks <br /> F Other: I I <br /> Contractor Company <br /> Signature Registered Y / N I Fee Current I Y/ N I <br /> Address I <br /> I License # <br /> , <br /> ELECTRICIAN A--''' Company • /} / r p �.� WA C I <br /> Signature Registered Y / N Fee Current J Y / N .fin <br /> Address 1 13/ 1 ./ 5&771 C!` Al ie QDJ C'l hrweate- S !rU,oI License # er 000///(.., I <br /> PLUMBER Company <br /> Signature Registered Y/ N j Fee Current I Y/ N I <br /> Address I <br /> License # I <br /> MECHANICAL Company <br /> Signature Registered Y / N I Fee Current I Y/ N J <br /> Address I <br /> I License # I J <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I 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) <br />