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813 -780 -0020 City of Zephyrhlls Fire Fax- 813 -780 -0021 <br /> Permit Application <br /> Date Received ) I Phone Contact for Permit 1 — 7 a7 1 1 556 I I eD 1 <br /> Owner's N a m e • )) Comm v n5 LI-C. L -C. Owner's Phone Number 1 813 9 (26..a <br /> Owner's Address I Jj 9 me k c - & . GI, Q,,,, Fe, 33a/ g- ao y R X a oC <br /> Fee Simple Titleholder Name I I Titleholder Phone Number I 1 1 I <br /> Fee Simple Titleholder Address I <br /> <. : „i. c. . '71R61, . ..... -.::r A�,.�. 3 ...,.',`e,"*r �., .. :� " ,r . ,» -m . ,.,.. , _ "a5a� er ..:.;N"� �_...., .s . -u'; : €� s...2;..', <br /> Job Address 6, // Zito �Q,fifyrhl//SP a3-5 Lot# 1 / Y <br /> Sub Division I ( Parcel # 13CS mss a / 0 /3o- 00000 Q/ v <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 /> El Controlled Burn 1E1 LP /Natural Gas - Installation <br /> El Emergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale <br /> El Emergency Generator > 30 kw n Places of Assembly- ANNUAL <br /> 7} Fire Protection Maintenance - ANNUAL n Recreational Burn <br /> (Qtrlyl emi LW Other <br /> Sprinkler 0 ❑ ❑ ❑ n Sparklers <br /> Fire Alarm i ❑ ❑ V 1 1 n Sprinkler System Installations <br /> Hood Cleaning LI ❑ ❑ ❑ 1 1 n Standpipes (Sprinkler Sys) <br /> Hood Suppression n ❑ ❑ ❑ I ( n Torch Roofing/Tar Kettle <br /> n Fire Alarm Installation n Waste Tire Storage ANNUAL <br /> El Fire Pumps <br /> n Fire Works <br /> n Flammable Application- ANNUAL <br /> 1 I Valuation of Project <br /> �I Fuel Tanks <br /> El Other: I <br /> Contractor Company <br /> Signature Registered Y / N I Fee Current I Y/ N I <br /> Address I <br /> I License # <br /> ELECTRICIAN 44s- Company / ". Peelle - - , • ,, ■ <br /> Signature Registered Y / N Fee Current NM <br /> Address [L..% J 56 T ' a ny qo_ Ate. ig 3/( d License # ( EP 000//lkj I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y / N J <br /> Address I <br /> I License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N ,J Fee Current I Y/ N I <br /> Address I <br /> I License # <br /> OTHER Company <br /> Signature Registered Y/ N ] 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 />