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C <br /> 813 - 780 -0020 City of.Zephyrhilis Fire Fax -813- 780 -0021 <br /> Permit Application <br /> DE lived I <br /> Phone Contact for Permit <br /> 1 <br /> Owr,er's Name 1 644./4 s74I•C Owner's Phone Number 1 7 1 1 ?6 I 1 (o' a,r <br /> Owner's Address 7 9 ' fi - 2403 Z ' fr.L J/f ,- 335 - '/ <br /> Fee Simple Titleholder Name Titleholder Phone Number I I I I <br /> Fee Simple Address I <br /> Job Address Lot # l <br /> Sub Division Parcel # I <br /> _,,e,. rs:•. ° "., 4.:•:' x. 4 .s,•;. ,, e.«, n "* '":.'3' M ktra .. , }. SIN ... ` . iltit alOW <br /> n Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> El 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 /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> Iutriyl (Semi' l J Other <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm IT ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning j " ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression 0 ' ❑ ` ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> FT Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> Flammable Application- ANNUAL I 1 Valuation of Project <br /> I I Fuel Tanks <br /> 0 Other: 1 <br /> Contractor Company <br /> Signature Registered Y/ N I Fee Current 1 Y / N <br /> Address I ( License # I <br /> ELECTRICIAN Company <br /> Signature I Registered Y / N ,I Fee Current I Y/ N I <br /> Address I License # <br /> PLUMBER Company <br /> Signature Registered Y/ N J Fee Current 1 Y/ N <br /> Address ( I License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N J Fee Current I Y/ N <br /> Addres I License # <br /> OTHER Company , , u�e .,erE- R 2/n e�./7" eZ•C- • I <br /> Signature O-Y7 Registered c' N Fee Current / N <br /> Address License # <br /> w•.. L aeaeY.l�yr:.✓m".p+>rd2:!`a <br /> 6 4 <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 />