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813-780-0020 City Of ZephyrhillS Fire Fax- 813-780 -0021
<br /> Permit Application
<br /> Date Received J eg I Z 0 I 10 1 Phone Contact for Permit 1 Q bq
<br /> 1\1\-0•2-1 ^1 n , 3 I��+�Il 6 4
<br /> Owner's Name n Q-- l y N e D E y\ c,� la..A IBC s r Owner's Phone Number g 1 1 7 3 - 7 - 7 7)
<br /> Owner's Address _d a 9 ( s ±: S -1--f r_c + 2 k r yt t • t S
<br /> Fee Simple Titleholder Name f / Titleholder Phone Number
<br /> Fee Simple Titleholder Address 1
<br /> Job Address 5 A f \A E- Lot #
<br /> Sub Division Parcel #
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<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 - 1 Controlled Bum n Hood Installation
<br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> n Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale
<br /> ® Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> IUtrlyl ISemil ma other
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ 1 1 1 1 Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ 1 I n Sprinkler System Installations
<br /> Hood Suppression El ❑ >1i, ❑ 1 1 n Standpipes (Sprinkler Sys)
<br /> 1 -1 Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> H Fire Pump n Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> n Flammable Application- ANNUAL I 2-00 O° I Valuation of Project
<br /> n Fuel Tanks
<br /> I Other: I
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<br /> Contractor ---.. Company ; /-G Iyh lei; fi I
<br /> Signature - -__ Registered C N I Fee Current Y/ N
<br /> Address 1 Pt, , g ©x g Lci.1A. ai( - 3i 63ci 1 License# I 1
<br /> ELECTRICIAN Company
<br /> Signature Registered Y/ N I Fee Current I Y / N I
<br /> Address I I License # 1
<br /> PLUMBER Company I
<br /> Signature Registered Y/ N I Fee Current I Y / N I
<br /> Address I I License # 1
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N . 1 Fee Current 1 Y / N I
<br /> Address 1 I License # I
<br /> OTHER Company
<br /> Signature Registered Y/ N _I Fee Current I Y/ N I
<br /> Address 1 License # 1 1
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<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)
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