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812 .-30 -0020 City of Zepihyrh Ifs Fire #- / l 01'I Fax - 313 - 780 -0021 <br /> Permit Application <br /> Date Received <br /> Phone Contact for Permit <br /> Owner's Name STMPT,FXGRTNNELL Owner's Phone Number <br /> - 1 813 1 626 I 15482 <br /> Owner's Address 4701. Oak Fair Blvd TAMPA FL 33610 <br /> Fee Simple Titleholder Name I - E Titleholder Phone Number I I j I <br /> Fee Simple Titleholder Address <br /> , :f. ' -. � .� ..- a 1: sc:HAR-.. rev ;...em �,. k r x - <br /> , <br /> Job Address / t0- q 3 eicil( ( 1VA, �� l r ,� ��. .... .<,__ t. S_�_�, Lot # F <br /> Sub Division I Parcel* I <br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier If or RQ Facility) ANNUAL <br /> I . Controlled Bum I Hood Installation <br /> I : Emergency < 30 kw n LP /Natural Gas - installation <br /> :. I Emergency Generator> 30 -kw I — I LP /Natural Gas - ANNUAL Sale <br /> I Fire Protection Maintenance - ANNUAL I I Places of Assembly-ANNUAL <br /> '(.ltrly 'Semi 'A °I! Other <br /> Sprinkler _ ❑ ❑. J l Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑. j 1. 1 1 Sparklers <br /> Hood Cleaning I ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression I I p El ❑ I <br /> ( a rm Installation 1...-..-: h ` Fire Al Itll I r . f Toach Roofing/Tar • <br /> , � 1 ( Fire Pumps • I - I' - Waste The Storage ANNUAL <br /> Fire Works <br /> :; n ' Flammable Application- ANNUAL <br /> I (( aluation of Project <br /> 1 <br /> V <br /> I <br /> Fuel Tanks <br /> ::; r ; t I Other: <br /> • <br /> i~ _„-rm « x I <x , , 7i-- -: _ - x'.._. m mr41: z'. : ,-. ?„,mr , r.<.. '?._,... -wsr=.m-r" '' :�.n. ..x, s >. <br /> Contractor r ` <br /> Signature Company .3 (yri ipb, X6,. e( <br /> Registered Y/ N Fee .Current I ' Y/ N j • <br /> Address I ;. . <br /> License # <br /> ELECTRICIAN L <br /> Sighature <br /> • I..Y /N <br /> Address I 1 �' <br /> PLUMBER . <br /> c� <br /> `1 <br /> Signature � �c. K— I J / <br /> Address I 111 T " 1 <br /> R r tyi ' <br /> MECHANICAL .-0._ Signature I -‘ r <br /> Address I.,.: � r � N I <br /> b <br /> OTHER �" r I I <br /> Signature 1 / N <br /> • <br /> Address J <br /> r < < I <br /> - - ". -- <br /> Directions <br /> • . Fill out application completely. <br /> Owner & Contractor sign back of application, notarized (Or, copy of sig <br /> If over $2500, a Notice of Commencement is required_(Mechanical wo �^ <br /> - Supply two (2) sets of drawings with applicable documentation . ' c t let <br /> 14'.. \ - All 10 -14 days for review after submittal date. Parcel # - obtained tto&, , . _ , U I -.corn) <br /> • <br />