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813 - 780 -0020 City of.Zephyrhiils Fire- / Max - a 1 J otJ-I,UZ. 3 . • <br /> Perm Application O 7 - <br /> Date Received Phone Contact for Permit , / G __ 1 /5s7 <br /> Owner's Name (b(arF 0 PSQ.p-pY S Owner's Phone Number <br /> 1 1 I I <br /> Owners Address 1603 & A # . L4 R•I4 us ) GC- 33.14:- . <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> f <br /> Fee Simple Titleholder Address <br /> 1 <br /> z <br /> Job Address - (9(44(- 2'b Zean 1ktu.% , Ft-- Lot# <br /> Sub Division Parcel # <br /> El 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 /> El Controlled Bum n Hood Installation <br /> E Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> ED Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> r y ems jr Uther <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm ❑ ❑ ❑ 1 I n Sparklers <br /> Hood Cleaning n 0 ❑ ❑ 1 I n Sprinkler System Installations <br /> Hood Suppression D ❑ ❑ ❑ 1 1 n Standpipes (Sprinkler Sys) <br /> El Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL • pp Valuation of Project <br /> Fuel Tanks <br /> 0 Other: I I <br /> Contractor Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current 1 Y/ N J <br /> Address I I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # I <br /> MECHANICAL Company <br /> Signature Registered Y / N I Fee Current I Y/ N <br /> Address I I License # I <br /> OTHER ci f l • Company �ZQ /t i /C//t(= 44 Ave-Laki /4,14 • <br /> Signature �'�_ jr� i�— Registered 3? N I Fee Current I Y/ N J <br /> Address z2"/ ,t/• 7O 1 ST. / 3-:. 53/f License # B 0 r..I0aJJ9 '" <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 />