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813-780 -0020 City f.Ze h rhills Fire <br /> tY P Y ' 0 Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit <br /> � . �... . � _ � _ _,_ �,. ,>�.. � �� . Win- � ,., x, s�.•�� � �� tt p�� <br /> Owner's Name ) Al-1-4 A 4X CJTOReli o F Z" K 1 LLS Owner's Phone Number <br /> 1 I �' V <br /> Owner's Address (G,a if FeK,T fiitia lei. <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> Job Address Lot # <br /> Sub Division Parcel # <br /> El Bio-Hazard Waste Storage - ANNUAL n FumigationTent <br /> n Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> FT Controlled Bum = Hood Installation <br /> Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw I LP /Natural Gas - ANNUAL Sale <br /> 7 I Fire Protection Maintenance - ANNUAL NI Places of Assembly- ANNUAL <br /> r y ems j Other <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm IT ❑ ❑ ❑ I 1 n Sparklers <br /> Hood Cleaning E ❑ ❑ ❑ i I n Sprinkler System Installations <br /> Hood Suppression 0 ❑ ❑ ❑ I I = Standpipes (Sprinkler Sys) <br /> FT Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> n Flammable Application- ANNUAL I I Valuation of Project <br /> n Fuel Tanks <br /> Q Other. I <br /> Contractor Company <br /> Signature Ryhetzt4 C /J2144A Registered Y / N ] Fee Current I <br /> Address I I Y / N J <br /> I License # I <br /> ELECTRICIAN Company <br /> Signature I Registered Y/ N 1 Fee Current I Y/ N <br /> Address I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N 1 Fee Current I Y / N I <br /> Address I I • " License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y/ N - I <br /> Address I I License # <br /> OTHER <br /> Company <br /> Signature Registered Y / N Fee Current I Y/ N <br /> Address License # <br /> 104 <br /> Directions: <br /> • <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 /> • <br />