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813 =780 -0020 City ofZephyrhilis -Fire, '//°'13 Fax -813- 780-0021 <br /> Permit Application <br /> Date Recct u <br /> Phone Contact for Permit <br /> Owner's Name STMPT:FXGRTNNFLL Owner's Phone Number 813 626 5 4 8 2 <br /> Owner's Address 4701. Oak Fair Blvd TAMPA FL 33610 <br /> Fee Simple Name - • Titleholder Phone Number <br /> Fee Simpie Titleholder Address I € <br /> v � � - ,ac':,u.... ,_ .� - 0-.....,m.,, rx.._.��. �� _ ..... -�: -�:, •: ;.�.;�. <br /> 2 <br /> �•`Y" �.t � ..:,� .r: ... �"...__:. ��.,�as_� .,_,�:r. ,_.. ..��.�..,v •"�" -a ...,,. �.,...- _ `, ..�,w . -- .� .w <br /> Job Address �Sd p- 7? Q ( � avev `iocs•1 o Lot# <br /> # . <br /> Sub Division <br /> • I Bio- Hazard Waste Storage - ANNUAL I Fumigation Tent <br /> I I Comm Exhaust Kitchen Hood /Duct Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum Hood installation <br /> L -- 1 Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> - - I I Emergency Generator > 30 -kw I LP /Natural Gas - ANNUAL Sale s <br /> Fire Protection Maintenance - ANNUAL . • Places ofAssembly- ANNUAL .. i ' <br /> L � - lAnl i Other • <br /> Sprinkler v ED DI • Recreational Burn te <br /> Fire Alarm I ( IA ID ❑ I , I, I Sparklers . 5 .W y <br /> rb IN <br /> Hood Cleaning In ❑ ❑ 1 Sprinkler' System Installations (.. fi <br /> Hood Suppression - I ❑ 0 -0 = 1 1 Standpipes (Sprinkler Sys): - <br /> I I Fire Alarm Installation Torch Roofing/Tar Kettle <br /> Fire Pumps r ----- 1 Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL ! , Valuation of Project <br /> I l' . , Fuel Tanks • <br /> • I Other .I <br /> am— " - - r t... r. :E ,>. • u . 7 mt9= `,. _ —7 -t Wa', e .4. . • = .ie !zrzs '..: e"svga.F 0-r -.I WZ ':er kae <br /> Contractor Company 3 (ti Ks-n•v't. �.( <br /> Signature Registered Y / N I Fee Current L Y / fit <br /> Address I `f I • <br /> • License # I • I . <br /> ELECTRICIAN Company . • <br /> Signature - - .. . - ' Registered ? Y 1.N I Fee Current I Y / N <br /> Address I . . . . I License # . <br /> PLUMBER Company <br /> Signature Registered Y / N ' I Fee Current I Y /- N. JJ <br /> Address 1 I License # . ' .. I <br /> MECHANICAL • Company <br /> Signature Registered Y/ N I Fee Current Y / N j <br /> . Address I. I License # I I <br /> OTHER - Company - - <br /> Signature Registered L Y / N I Fee Current Y / N <br /> Address <br /> .. .. - ...�.... >�..� ,,,�:.•__ - a . - �_._.,�r _. a:: =.= - .�.. '<°.._ ...asp <br /> License # <br /> - , <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 d - (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 />