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a1 7s ,Q20 City ofZephyrhilis "Fire
<br /> 106'1/1 Fax -813- 780 -0021
<br /> - Permit Application
<br /> Date Received ::
<br /> _..,� a. _,..eg_— •,,.. .._. _..._.,,,._ -..._ - _. -<- a r .,,,,,..
<br /> Phone Contact or Permit
<br /> Owners Name
<br /> S TMPLF,XGRTNNET,L — 1 wner's Phone Number 813 626 4 8 2
<br /> Owner's Address 4701 Oak Fair Blvd TAMPA FL 33610 PVI`+( t1/ hi UrS 140/0 E.
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address �� y3 1
<br /> T,z" h b -z 0 = =.-" ,n. .. ' .,.._ _Wi eee � �+°` s'� .�4 ass'° :`- "..,: ,4- _ F P`Atig ^_... T
<br /> Job Address 3 S 2 So A-ve _. Z a h h 'tit S F L- .S 5 2— Lot #
<br /> Sub Division Parcel #
<br /> .i, .,:.: _ , ",- :,' - ^.. r;o. .., " '. ,, - .�.,,.. — - w —�`' akm zee M- rags_ •- ,_,e:_ r,+7.':;,
<br /> I Bio- Hazard Waste Storage - ANNUAL I Fumigation Tent
<br /> I I Comm Exhaust Kitchen Hood /Duct Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> I . I Controlled Bum I Hood Installation
<br /> I I Emergency Generator < 30 kw I LP /Natural Gas - Installation
<br /> . i:. I Emergency Generator > 30 kw I LP /Natural Gas - ANNUAL Sale
<br /> I I' Fire Protection Maintenance - ANNUAL I Places of Assembly- ANNUAL
<br /> L i O Semi 1 !Ad f Other
<br /> Sprinkler 11151 11 ❑ ❑. I I Recreational Bum
<br /> Fire Alarm I ( ❑ ❑ ❑ I (, I I Sparklers
<br /> Hood Cleaning 0 ❑ ❑ I 1 1 I Sprinkler System Installations
<br /> • Hood Suppression I ❑ ❑ ❑ I I I I Standpipes (Sprinkler Sys)
<br /> F I . Fire Alarm installation I ) Torch Roofing/Tar Kettle
<br /> I •. I Fire Pumps I Waste Tire Storage ANNUAL
<br /> I I , Fire Works
<br /> Flammable Application- ANNUAL I • II Valuation of Project
<br /> - I r Fuel Tanks •
<br /> I I.
<br /> Other: I . •
<br /> 3.u`s'r` a „ -r ' a .: .,¢.,, , , —it, ?:. r�:a wv5'+m .., ,c s .e.,,5:v.•_ -. .'2 •<c _::,..- 5r__ • i 86;* ,_.- .,,,, ,: a,
<br /> i
<br /> Contractor ' Company 3 CYO` c Fw+* •t Lt
<br /> Signature Registered Y/ N 1 Fee Current L Y/ N I
<br /> - Address . . . .. I . License # . . •
<br /> ELECTRICIAN Company
<br /> Signature - Registered • Y / N 1... Fee Current 1.. :Y / N ; I ,
<br /> Address I I License #
<br /> PLUMBER Company
<br /> Signature Registered Y / N 't Fee Current 1 Y / N; 1
<br /> Address I I License # . • I
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N I Fee Current 1 Y/ N I
<br /> . Address I, ,. .. I License # I I
<br /> OTHER Company - -
<br /> Signature Registered Y / N I Fee Current Y / N J
<br /> Address -
<br /> License
<br /> Directions:
<br /> FiII 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 (httpl /appraiser.pascogov.com)
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