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rax - o -r au r • <br /> 813 787 - 0020 City ofZephyrhilis Fire • <br /> Permit Application <br /> Date Received Phone Con ct or Permit Mill lii/ <br /> Owner's Name Aj j/ /1.) /4C?117L 444 Owner's Phone Number 1 <br /> Owner's Address ?La" al1ds.ph,' 044 o,► — 1.4- AA 492,4 CYv+'/'9, A4 • /'9000 Z./ oz. <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address 13 6414.. Re>• Z4- "mss, I#C • Lot # <br /> Sub Division Parcel # 3• rs • Z/ • Dem • cegre30 • 40 00 <br /> n Bio-Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> a Comm Exhaust Kitchen Hood/Duct r Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum I Hood Installation <br /> 0 Emergency Generator < 30 kw pi LP /Natural Gas - Installation <br /> 0 Emergency Generator> 30 kw n LP/Natural Gas - ANNUAL Sale <br /> El Fire Protection Maintenance - ANNUAL n Places of Assembly - ANNUAL <br /> 7171 emi WA utner <br /> Sprinkler ❑ ❑ ❑ 7 Recreational Bum <br /> Fire Alarm LJ ❑ ❑ ❑ 1 1 n Sparklers <br /> Hood Cleaning Ei ❑ ❑ ❑ 1 I n Sprinkler System Installations <br /> Hood Suppression E=I ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> 0 Fire Alarm Installation FT Torch Roofing/Tar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL r; , - Op Valuation of Project <br /> Fuel Tanks <br /> El Other: I I <br /> Contractor Company I <br /> Signature Registered Y/ N Fee Current I Y / N <br /> Address I I License # I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N <br /> Address I I License # l I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current 1, 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 /> OTHE'l jI �� Company ,{0 Abu, 0,40,4 l S ,K • <br /> Signaturb alb Registered Y N I Fee Current I Y/ N 1 <br /> Address Sf./ O 5T• ', ,,,. '— License # r •t IrZ000 / i "gg <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 (httpi /appraiser.pascogov.com) <br />