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813-780-0020 v <br /> City ofZephyrhills - Fira. I Fax -313- 780-0021 <br /> Permit Application <br /> Date Received � - - <br /> - Phone Contact for Pe it <br /> Owner's Name S TMPT,FX GRINNELL /C I r j ct l Owner's Phone Number 1 81 3 I I 626 115 4 8 2 <br /> Owners Address 4701. Oak Fair Blvd TAMPA FL 33610 <br /> Fee Simple - titleholder Name I • - J Titleholder Phone Number ' 1 1 1 1 <br /> Fee Simple Titleholder Address i <br /> Job Address 1 i (kq 11 r l V �,_ . Z e. Pn �I r h ,115 L-- 3 5 S L I 1 Lot # I <br /> Sub Division I "k Parcel # I <br /> =:..; �K+.-..^ �' ?.`. ��-.--. a;Y�<.3.r.�-".- .:. °"�r��.c5'3,' <'�.�' : -i0-,. �ta�.e... -�. -sue.. � _ + -" +�i •_$- =-�T^ - ��:,: Pn.�n^�'.rn <br /> ', Bio- Hazard Waste Storage - ANNUAL I Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct ' Hazardous Material (Tier If or RQ Facility) ANNUAL <br /> I. i - Controlled Bum I Hood Installation <br /> I I Emergency Generator < 30 kw I LP /Natural Gas-installation <br /> • <br /> I Emergency Generator> 30 kw ' i LP /Natural Gas - ANNUAL Sale <br /> _ Fire Protection Maintenance - ANNU• i Places of Assembly-ANNUAL <br /> — „ rai NM' lAnI j !Other <br /> Sprinkler r0- - ❑ ❑. I I Recreational Burn <br /> Fire Alarm ❑ ❑ O. I • • 1 : 1 f Sparklers <br /> • <br /> • • . Hood Cleaning I 1 ❑ ❑ ❑ I 1 1 I Sprinkler System lnstallation5 <br /> ' 0 -0 <br /> Hood Suppression - 1 i ❑ 1 <br /> ! 1 i Standprp <br /> es (Sprinkler Sys) <br /> Fi Alarm lnsfallation <br /> __._..... .._:- �_...• I � - .Torch Roofing/Tar Ketfle ' <br /> I ( . Fire Pumps <br /> I • Waste Tire Storage ANNUAL • <br /> I Fire Works <br /> - • . . • <br /> 1' pP UAL / <br /> Flammable A lication -ANN : j Valuation O <br /> aluatio of Project <br /> ,• <br /> Fuel Tanks <br /> I . • 1 . Other: I <br /> 3v. "i 0 - 1, = '_"`vi.Y- - <2.:.'�- v'.c:::: ysx „ri:'Si's'it�.t a ..^;r .,. �:ac.;Ss ri!�L_ "' 5tt,�z� -.u' _.mss.:, _ '.. • <br /> Contractor :mower <br /> Signature Company 3 �y7 ',rr 1 <br /> ," ' ( Registered Y / N • Fee Current ' Y / N <br /> Address i <br /> License # <br /> ELECTRICIAN , <br /> I <br /> Company . • . <br /> Registered Y / N i Fee Curre � „ , Y/ N- I <br /> Signature ., <br /> Address <br /> I i License # I 1 <br /> PLUMBER <br /> Company . I , <br /> Signature r <br /> Registered Y1 N i Fee Current Y/ N : • <br /> Address i i License # . I • f <br /> MECHANICAL Company • 1 <br /> • <br /> Signature I Registered I YIN Fee Current Y/ N <br /> . Address - 1 <br /> i License # I i <br /> OTHER Company <br /> Signature Registered Y/ N Fee Current I Y / N J <br /> Address <br /> License # <br /> Directions: - <br /> - Fill out application completely_ <br /> - <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> ff 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 (httpf /appraiser.pascogov.com) <br /> • <br /> • <br /> • <br />