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813-780 -0020 City of Zephyrhjus Fire' Fax -813 -780 -0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit J I <br /> Owners Name . i�.€)C, ( .c, L �- Owner's Phone Number L 7 1 t).2.7___ 4 '71/ <br /> Owner's Address s . VC, % 635z-Z6.- z vp / e°/ ,,i, A ,�- . <br /> Fee Simple Titleholder Name Titleholder Phone Number I I f I <br /> Fee Simple Titleholder Address <br /> Job Address I <br /> Lot # <br /> Sub Division Parcel # <br /> i7;t�'�•k a c,xe z.. .x3 a+ -sta - �;�.,.ra :.r„� . t._..;.: ..x �.F- °sr. .,.,a< - ^_ >_F e ,.,.��s:� .. -��, x.s- -,, a .,w- wt�,:�..r ,c- a„3�e^m��aa., .+^m .:,,e.l . <br /> El Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> [I Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I] Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw r---] LP /Natural Gas - ANNUAL Sale <br /> f ] Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> IUtny( !ben l T:LU Uther <br /> Sprinkler ❑ ❑ ❑ I Recreational Bum <br /> Fire Alarm I ❑ ❑ ❑ I I I I Sparklers <br /> I I <br /> Hood Cleaning ❑ x ❑ I I n Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ I I jJ Standpipes (Sprinkler Sys) <br /> I I Fire Alarm Installation Ii Torch Roofing/Tar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> I I <br /> Fire Works <br /> n Flammable Application- ANNUAL I I Valuation of Project <br /> I I Fuel Tanks <br /> [ T Other: I <br /> Contractor Company <br /> Signature <br /> Registered Y / N j Fee Current I Y / N I <br /> Address I I License # I <br /> ELECTRICIAN Company <br /> Signature Registered Y / N J Fee Current I Y / N <br /> Address I I License # <br /> PLUMBER Company <br /> Signature Registered Y / N j Fee Current I Y / N <br /> Address I I License # I <br /> MECHANICAL' ( Company <br /> Signature Registered Y / N Fee Current I Y / N <br /> Address I I License # <br /> OTHER <br /> ( Company <br /> Signature � �j/t_ 1 Yr / ' ' / _- `/'!/t) ed., 14. <br /> Address Registered rg� Fee Current ream <br /> License # ` YJ• r <br /> Directions: <br /> .. ., . -.. _ .. . <br /> Fill out application completely. <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> tf 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 />