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813 -780 -0020 City of ZephyrhillS Fire -- . Fax -813- 780-0021 <br /> Permit Application _ <br /> Date Received - Phone Contactfor Permit Ma _ l N. 2 J/ 9 5- • <br /> • Owner's Name n1 E y_/,%/,� �+!' 1 11/Z ��` 7,,IV {� Owner's Phone Number <br /> Owner's Address 4g/338 - ,L - <br /> Fee Simple Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address Lot # <br /> Sub Division Parcel # <br /> n Bio-Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> El Fire Protection Maintenance - ANNUAL ® Places of Assembly- ANNUAL <br /> 1c.ttny1 1Semii raj Utner <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm El ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning E ❑ ❑ ❑ 1 1 n SprinkierSystem Installations <br /> Hood Suppression Ei ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> l I Fire Pumps n Waste Tire Storage ANNUAL <br /> El Fire Works <br /> Flammable Application- ANNUAL I I Valuation of Project <br /> Fuel Tanks <br /> n Other: I <br /> Contractor Company <br /> Signature Registered Y / N Fee Current I Y/ N <br /> • <br /> Address I I License # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address 1 I License # <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # <br /> MECHANICAL Company <br /> Signature Registered Y / N Fee Current 1 Y/ N <br /> Address I I License # <br /> OTHER � � Company <br /> Signature ° ?Alt: c ie� /�CaE�� Registered Y / N ( Fee Current I Y / N 1 <br /> Address at - /' � 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 />