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813 -780 -0020 City of.Zephyrhilis Fire Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received • l Phone Contact for Permit <br /> L <br /> Owner's Name I �t �/! JA i e ?4 Owners Phone Number 8/3 120 3 4 717 <br /> Owner's Address 378/,- /.-- Ayr <br /> Fee Simple Titleholder Name 'tie/ - z - AL Titleholder Phone Number <br /> Fee SimpleTitleholder Address I <br /> Job Address Lot # <br /> Sub Division I Parcel # <br /> ED Bio- Hazard Waste Storage - ANNUAL I—I Fumigation Tent <br /> n Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> El Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL = e r <br /> Fire Protection Maintenance - ANNUAL ED Places of Assembly -A UAL ( <br /> r y emi I Other I <br /> Sprinkler ® ')a ❑ ❑ Recreational Bum -/ <br /> Fire Alarm pc ❑ ❑ I 1 Sparklers <br /> Hood Cleaning CI ❑ ❑ ❑ 1 I n . Sprinkler System Installations <br /> Hood Suppression CI ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> El Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> n Flammable Application- ANNUAL ` Valuation of Project <br /> n Fuel Tanks <br /> n Other: I <br /> Contractor Company litriffrl �: <br /> Signatu - `� �(/� Registered Y / N Fee Current Y / N <br /> • ddre , - License # <br /> ELECTRICIAN Company <br /> Signature I Registered Y / N I Fee Current I Y / N I <br /> Address I I License #. I I <br /> PLUMBER Company <br /> Signature Registered Y/ N J Fee Current I Y/ N 1 <br /> Address 1 I ' License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # <br /> OTHER Company <br /> Signature Registered _ Y/ N I Fee Current I Y/ N <br /> Address 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 />