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813-780 -0020 City ofZephyrhilisFii ':-- c' Fax- 813 - 780-0021 <br /> Permit Application <br /> Date Received 1 Phone Contact•for Permit <br /> xa <br /> Owner's Name 1 SSteVy /10110 m ob tie. E - - t -e s l Owner's Phone Number .- 1 _. _ 1 <br /> 1 <br /> Owner's Address 138/9 l.cinsing 110e.nat - 24.0-1$1 hi 115 FL- 33S -a <br /> Fee SimpleTitleholder Name , Titleholder Phone Number <br /> Fee Simple Titleholder Address , I <br /> Job Address v-\fa 13 O t-I- I R (.1 E - 2_e_pb h I'/.5 FL_ 33 5 7Z Lot # <br /> Sub Division J ! Parcel # <br /> l l Bio-Hazard Waste Storage —ANNUAL n Fumigation Tent <br /> 1 Comm Exhaust Kitchen Hood/Duct r 1 Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I — I Controlled Bum I Hood Installation <br /> IT Emergency Generator < 30 kw I LP/Natural Gas - Installation <br /> I I Emergency Generator> 30 kw I LP/Natural Gas-ANNUAL Sale <br /> n Are Protection Maintenance - ANNUAL - I 1 I Places of Assembly ANNUAL <br /> • )bemrl raj utner <br /> Sprinkler ED ❑ ❑ ❑ D Recreational Bum <br /> Fire Alarm E ❑ ❑ ❑ I I I I .Sparlders <br /> Hood Cleaning El ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression El ❑ ❑ ❑ .) I n Standpipes (Sprinkler Sys) <br /> I — I Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> NI Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application - ANNUAL I Valuation of Project <br /> Fuel Tanks <br /> Q Other. I <br /> Contractor /1 [ Company <br /> Signature V� / ; - �j - - - , � . Registered Y / N . I Fee Current ' Y / N <br /> Address 1 I — License # I <br /> ELECTRICIAN Company <br /> Signature Registered Y / N I Fee Current I Y / N 1 <br /> Address I I License # <br /> PLUMBER Company <br /> Signature Registered Y / N- J Fee Current I Y / N I <br /> . Address I ' <br /> I License # ) I <br /> MECHANICAL Company <br /> Signature .. Registered Y / N J Fee Current I Y / N I <br /> Address I I -License # <br /> OTHER Company <br /> Signature Registered Y/ N. I Fee Current I Y/ N J <br /> Address <br /> Directions: canes <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.(Mechanicai 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 (httpJ/appraiser.pascogov.com) <br /> • <br /> • <br />