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<br /> 813=r80 -0020 City ofZephyrhilisFire Fax -813 -780-0021
<br /> Permit Application
<br /> Date Received r:- Phone Contact for Permit
<br /> yam_ .. _
<br /> Owner's Name S Tp4PT,EXGRTNNELL it'w.w ` )-e.i , -svv, 6 Owner's Phone Number 813 626 54 8 2
<br /> Owner's Address 4701 Oak Fair Blvd TAMPA FL 33610
<br /> Fee Simple Titleholder Name • ' Titleholder Phone Number
<br /> Fee Simple Titleholder Address 1
<br /> ., .. - : - a v -:,?r- srv .: e-rv__".t = - .:�.... ,?".e S.I. '3 �. '`T.. .: : r_. 'c`'"`> ,. ._:. - cav- f:ga:,cx:.- _..`- 1" ,s;:: "ti ..:�t..c' °- c a.'�` a ,v�3Z:� ff _.� _,. . ill- ._ - 4
<br /> Job Address . > J S 1 L� S , ie,Rh y (h 1 US L 33 s Z ►y� h t��s � l�jh Lot #
<br /> Sub Division Parcel �
<br /> 'r' � .. - a $ Y.. ...., •:. ra � ::-..W�. u:.:.°,, .�tea ..sis;zaTi z.:;..dmm..�
<br /> .. ...�.::2; �.'�.�..` ...�.:�rMw m-,.t._ _..._............. F
<br /> Bio- Hazard Waste Storage - ANNUAL 1 Fumigation Tent
<br /> I Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier If or RQ Facility) ANNUAL
<br /> I . I • Controlled Burn 1 Hood installation
<br /> 1 Emergency Generator < 30 kw 1 LP /Natural Gas - Installation
<br /> Emergency Generator > 30 -kw �, •
<br /> 1 . Fire Protection Maintenance - ANNUAL
<br /> lUtrlyf'Semil ` t Cv.vAl� ...e...< ,,,h •
<br /> Sprinkler . 1 ( ❑ . ❑ N V J
<br /> Fire Alarm r ❑ ❑ 9 Z�, ~
<br /> Hood Cleaning 0 ❑ \r) 1 ` \ S t, ,
<br /> Hood Suppression 1 I ❑
<br /> Y r a, � w0J\
<br /> 1.;,, 1 :, - , - . - FireAlarrn installation 1 Q. r�Jl J
<br /> 1 1 Fire Pumps \ ,,
<br /> : I i Fire Works \ 1`t'� 4--r Y `Gk `l•
<br /> tJ ' EL i rm i -
<br /> .
<br /> Flammable Application- ANNUAL tion of Project
<br /> ,
<br /> Fuel Tanks 0 n S 0-e,
<br /> I 1 Other I �J
<br /> •
<br /> Contractor / t
<br /> Signature �r(vv.%a_ `"?evezi , - ent 1' Y / N I •
<br /> Address 1
<br /> M- 31- 11031 • 1
<br /> ELECTRICIAN
<br /> Signature 7 Company
<br /> Registered t Y/ N 1 F eer Current 1 Y/ N I
<br /> Address License # 1 1
<br /> PLUMBER .- Company
<br /> Signature Registered Y1 N' 1 Fee Current' 1 Y 1 ht' E.
<br /> Address 1 I License # • 1 ' 1
<br /> MECHANICAL • Company
<br /> Signature Registered Y/ N 1 Fee Current Y / N
<br /> . Address 1,, ;, . I License # 1 1
<br /> OTHER Company -
<br /> Signature Registered Y / N 1 Fee Current Y / N
<br /> •
<br /> Address L
<br /> -• "`�•-• s e„ ,.., : , - ,:-...s .N_.,.�.�,. iri; r:z +=.. ' _a" � - - - .. is ... =- -• t - � -•!�.: :. cr� �._ - -�"^'y' 3W, ense #
<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 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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