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;c - ot7 i t <br /> p <br /> 813-780 -0020 City ofZephyrhilis Fire: ' (� 1 Fax -813- 78D -0021 <br /> Permit Application ` <br /> Date Received Phone Contactfor Permit <br /> C 2 r Z,' S Own s Phone Number ( Z <br /> Owners Name C+ ( Z r,a- C <br /> Owner's Address - 3 ( 6 O ( 'q • D. `^c (-4 ce, y ;" <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job ., ,,..,, -• ._, ., _. <br /> Address L I <br /> l 8 iv , Lot# • Sub Division Parcel # <br /> n Bio-Hazard Waste Storage -.ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct • n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw I 1 LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> 11:2F91 ' i Semi ( (I' tither il-LIyr- <br /> Sprinkler n ❑ ❑ ❑ , n Burn <br /> Recreational Bu <br /> Fire Alarm E ❑ ❑ ❑ I = Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I 1 1 A SprinklerSystem installations C r. <br /> H Suppression = ❑ ❑ ❑ • 1 n Standpipes (Sprinkler Sys) . /i <br /> f Q� • b `L <br /> n 1 Alarm Installation n Ton:h Roofing(Tar Kettle L G <br /> I-1 � Fire Pumps I I Waste Tire Storage ANNUAL t �2 <br /> Fire Works C) q 1 /10 �v <br /> l <br /> Flammable Application- ANNUAL - Valuation of Project <br /> I Fuel Tanks ++ _ <br /> El Other: I f, ''t? 1> • i - i( V` //�t CI'}°�J' - ,'- Pe ✓ yr �IC , fcvtG, f' Di: Ark rxviLt.i r- ; ,,e S /,,.,M2,'41 <br /> Contractor , (; /' Company E r .Z c. ci v c� j,2.. <br /> Signature Registered Y !.N Fee Current f / N <br /> Address .I License # I D y na I j1? e .. d s I <br /> ELECTRICIAN Company <br /> Signature , • Registered Y/ N I Fee Current Y/ N <br /> Address I • , License# I <br /> PLUMBER • Company <br /> Signature Registered Y/ N Fee Current I Y/ N <br /> Address I I License # <br /> MECHANICAL Company <br /> Signature Registered _ Y / N I Fee Current I Y / N <br /> Address I • License # I <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current 1 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 /> • <br /> • <br />