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813 -780 -0020 City ofZephyrhillS-Fire Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received Phone Contactfor Permit 1 1 I <br /> Owner's Name B /h / /�19-1 ', ZZ / Owner's Phone Number ; ; 7 0.2 <br /> Owner's Address Sony 6 3L. ,,h. 2G1O r"�1 <br /> Fee Simple Name j ' 7tleholder 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 /> I I Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> 1 Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL • I I Places of Assembly- ANNUAL <br /> 1utrlyI !ben I J utner <br /> Sprinkler El ❑ ❑ ❑ I I Recreational Bum <br /> Fire Alarm El D ❑ ❑ I n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression ® ❑ X DI I n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation 1 1 Torch Roofing/Tar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> I I Fire Works <br /> Flammable Application- ANNUAL ' Valuation of Project <br /> n Fuel Tanks <br /> Other: 1 <br /> Contractor Company <br /> Signature Registered Y / N j Fee Current Y / N I <br /> Address I I License # <br /> ELECTRICIAN Company <br /> Signature Registered Y / N . 1 Fee Current I Y / N <br /> Address 1 I , License # <br /> PLUMBER Company <br /> Signature Registered Y / N 1 Fee Current I Y/ N j <br /> Address I I License # <br /> MECHANICAL Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address I I License # <br /> OTHER Company c,.5�' A� 7 /YLE Z ■19i 4+.T 44c_ <br /> �� <br /> Signature Registered 07/ N Fee Current N <br /> Address PTs�3��1 / <br /> License # r <br /> _. , . _.... <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 /> I <br />