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,. C I II- .4° , y 6 414'64C) <br /> 813-780 -0020 City of.Zephyrhilis 'Fire L..//) 1 L'" Fax- 813 - 780 -0021 <br /> Permit Application <br /> Date Received <br /> 17_ / Phone Contactfor Permit (4 3 N l 69 8' ? ? 4 / <br /> Owner's Name ✓ q r ,, ' 0 (' (^I V (Z Irk ( L LS (A) AT ( Owner's Phone Number <br /> g <br /> Owner's Address V 3 3 b Z° - S- g6 E a E PH `( r2 l-1 t C-1 S re- • ?31 Z <br /> Fee Simple Titleholder Name • Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> C <br /> Job Address Li 3 3 0 ,76 TN 5 � �` Er Z�PK`t R( -i«-LS F 33 > '1 Z Lot# <br /> Sub Division <br /> Parcel # <br /> ��'.'z`a":.. -,.. a .:�'. ,i,r'x.... - ,- ;n -,.w .,� - .,. ,.,�::,r ._r, ,.::. „ ,•.M . ,.:«.a,; . .: ° >� .�,.,...- �:?.:x -,.,,� - E: -:.'� .w.�'xvs."�.3""*,e'• $.di'"�d3'E��"'� w�,su ''iaTu�c:iai::: <br /> I Bio-Hazard Waste Storage - ANNUAL 1 1 Fumigation Tent <br /> n Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum n Hood Installation -` <br /> ti <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> 1 Emergency Generator> 30 kw <br /> 1 LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL 1 1 Places of Assembly- ANNUAIr'� g 1) <br /> )Lttnyi semis Nal other % A / 0 / pr n ❑ ❑ ❑ 1 Recreational Bum r f <br /> Fire Alarm n ❑ D ❑ I I Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I I I Sprinkler System Insta -tions <br /> Hood Suppression Ix I ❑ 5.t/ ❑ I I Standpipes (Sprinkler Sys <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle , <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL I I Valuation of Project <br /> Fuel Tanks <br /> n Other: 1 <br /> Contractor Company N 7 Y f RAI- 4 )6 C- (Su <br /> i`1 t 1-)5 <br /> Fee Current <br /> Signature � Registered Y / N Fe I Y / N <br /> Address 1 License # <br /> ELECTRICIAN Company <br /> Signature Registered Y / N I Fee Current Y/ N <br /> Address 1 I License # I <br /> PLUMBER Company <br /> Signature Registered Y / N I Fee Current 1 Y / N 1 <br /> Address , 1 License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N 1 Fee Current 1 Y/ N <br /> Address 1 I License # <br /> OTHER , Company <br /> Signature Registered Y/ N I Fee Current Y/ N <br /> Address . 1 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 />