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813 -780 -0020 City of Zephyrhuls Fire 0 j t 37 Fax - 813 -780 -0021 <br /> Permit Application <br /> )ate Received Phone Contact for Permit <br /> )wners Name IMP IIMI1 Owner's Phone Number 1 V3 1 7J6 - i To <br /> )wners Address I .5� l 4 1 �� r.L ' 4 i • - C 1 C 22 pLA r 11`,1 Its I. s 3 . H ",., 1/ <br /> :ee Simple Titleholder Name I Titleholder Phone Number I (, i <br /> =es Simple Titleholder Address I <br /> Job Address ` a■\, Lk F A 4 11 J \ / , (' \'\:i 1,,S '' 3 S �--- Lot # 1 <br /> l � i <br /> Sub Division (7 C r Z e 1- c . l S C Parcel # 111 — a16/ ' - 00 1 1 - kilo() Ji <br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> 0 Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier 1I or RQ Facility) ANNUAL. <br /> ED Controlled Burn n Hood Installation <br /> r --- 1 Emergency Generator < 30 k w E l LP /Natural Gas - Installation • <br /> Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> am 1 GLJ Utner <br /> Sprinkler ❑ ❑ ❑ 1 Recreational Bum <br /> Fire Alarm ❑ ❑ / 16 ( 1 El Sparklers <br /> Hood Cleaning ❑ ❑ ❑ ❑ 1 1 a Sprinkler System Installations <br /> Hood Suppression 0 0 ❑ ❑ I 1 n Standpipes (Sprinkler Sys) <br /> El Fire Alarm Installation 1 Torch_Roofing/Tar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> • <br /> Fire Works <br /> Flammable Application- ANNUAL 1 , Valuation of Project <br /> Fuel Tanks <br /> fl Other. I <br /> Contractor Company �, P . r lc " 5 v1 7 <br /> j,yiC, <br /> Signature `, Agh _ _ Registered Mai ee Current MEI <br /> Address 1 3 l 9 at ( lieu. ev- `♦ � Lr z „ e C'. \- F1 3 3 License* I E -p• \ Doc) l C) Li L41 1 <br /> ELECTRICIAN Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address 1 I Ucense # I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current ` Y/ N J <br /> Address I 1 License # I I <br /> MECHANICAL Company <br /> Signature Registered YIN 1 Fee Current Y/ N l <br /> Address I 1 License # 1 <br /> OTHER Company <br /> Signature Regiatered Y / N Fee Current Y / N <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:llappraiser.pascogov.com) <br /> I <br />