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813 -780 -0020 City of.Zephyrhilis' Fax-813-780-0021 <br /> Permit Application _ <br /> Date Received Phone Contact for Permit <br /> I <br /> Owner's Name (46(.4 / to yr) i/ ( c S Owner's Phone Number .9 13 7 ft z5 <br /> Owner's Address Pe- (" i/ gl vt 7 5111 <br /> Fee Simple - Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I I <br /> Job Address Lot # <br /> Sub Division Parcel # <br /> anflaireastammamoss <br /> n Bio-Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> I Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> I Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale <br /> 1 Fire Protection Maintenance - ANNUAL • n Places of Assembly - ANNUAL <br /> I'duly( !Semi' raii Other <br /> Sprinkler ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm El ❑ ❑ ❑ I 1 n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ 1 I I I Sprinkler System Installations <br /> Hood Suppression El ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> I - 1 Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> I I Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> Flammable Application- ANNUAL I ' Valuation of Project <br /> n Fuel Tanks <br /> n Other: <br /> Contractor Company <br /> Signature ` ' Registered Y / N I Fee Current I Y / N • <br /> Address I 5 3 / 7 &-31J /744/ 'Z -r/a . I License # I <br /> ELECTRICIAN • Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address 1 I License # I I <br /> PLUMBER Company <br /> Signature Registered Y/ N 1 Fee Current I Y / N I <br /> Address 1 I License # <br /> MECHANICAL Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address 1 I . License # <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current 1 Y / N <br /> Address 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 /> • <br />