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813 -780 -0020 City of Zephyrhi ls'Fiie 4' of 7A Fax- 813 -780 -0021 <br /> Permit Application <br /> late Received <br /> - Phone Contact for Permit <br /> lwners Name 2 6 ■ (I S. (+ Owner's Phone Number I i 5/ 1 k '3z-/ <br /> )wner's Address E L - . () < '7 �ti \ <br /> :es Simple Titleholder Name 1 1 Titleholder Phone Number I 1 , <br /> =ee Simple Titleholder Address I 3 <br /> .. .. . , _ kt« -. . _ VAR 9,. <br /> Job Address S 'A a. c ( . r . k 1 ` t) • , Lot # <br /> Sub Division I Parcel # . I <br /> n Bb- Hazard Waste Storage - ANNUAL Fumigation Tent <br /> ED Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> E Controlled Burn Ej Hood Installation <br /> I - I Emergency Generator < 30 kw 1 LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw [ LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL I Places of Assembly- ANNUAL <br /> =To waja mu ether <br /> Sprinkler 0 0 ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ (4 , 1 Sparklers <br /> Hood Cleaning ❑ ❑ ❑ I I 1 I Sprinkler System Installations <br /> Hood Suppression El ❑ ❑ ❑ I ` n Standpipes (Sprinkler Sys) <br /> El Fire Alarm Installation n Torch RoofinglTar Kettle <br /> R Wast Fire Pumps <br /> e Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL ' Valuation of Project <br /> Fuel Tanks <br /> Q Other I <br /> Contractor ` Company ' hl , L <br /> Signature , Registered maul Fe= Current <br /> Address Waelnr, t o u7 s , „run, r i r I License # I_ 100 b t 6 Li (..e I <br /> ELECTRICIAN 3 3 ` a. Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address I License # I <br /> PLUMBER Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address I' I License # - I <br /> MECHANICAL Company <br /> Signature Registered Y/ N 1 Fee Current 1 Y/ N I <br /> Address I I License # I <br /> OTHER Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N I <br /> Address I License # <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 />