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City p Y <br /> 913 ?pA -0020 C of.Ze h rhills'Fire 1 °C63 Fax- 813- 780 -0021 <br /> < < <br /> Permit Application <br /> / <br /> 08 /� �r✓ Phone Contact for Permit � ( : <br /> Date Received J I.. / (l as ! a S <br /> Owner's Name 1 k lS2L 0 H ORZ1/4TW ( Owner's Phone Xi; I .7 'g - / W <br /> C, <br /> Owner's Address 7 C� eV:1 q !3 i // /� j fl 73 & <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I � . <br /> nb ,,,. <br /> Job Address <br /> C '717'T , Z,' D-' CA . if/ 6>9LZ ;8GVI Lot # <br /> Sub Division 1 I Parcel # <br /> Bio- Hazard Waste Storage — ANNUAL 1 I Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> n Controlled Bum I Hood Installation <br /> I I Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> Emergency Generator > 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL r "' l I I Places of Assembly- ANNUAL <br /> Ic.ltnyl 'berm' I" Other <br /> Sprinkler n ❑ ❑ ❑ I Recreational Bum <br /> Fire Alarm I I ❑ ❑ ❑ I . 1 1 I Sparklers <br /> Hood Cleaning F.7 ❑ er ❑ I I Sprinkler System Installations <br /> Hood Suppression I ❑ ❑ ❑ I I I I Standpipes (Sprinkler Sys) <br /> rI Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> I I Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> I 1 Flammable Application - ANNUAL ` ( Valuation of Project <br /> I I Fuef Tanks <br /> Other: 1 <br /> Contractor ] Company (IN / L S - v V �C)t . <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address 1 1 License # I I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current 1 Y/ Ni I <br /> Address I I License # ( I <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N 1 <br /> Address I I License # ( I <br /> MECHANICAL Company <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I I License # I I <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current L Y/ N 1 <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 />