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813-780-0020 City of.Zephyrhilis Fire Fax - 813780 -0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit I I <br /> r =� ESL 6 3� iToU <br /> Owner's Name L, ?TLC Fly- L-,v A Sc - L o d L O V S L J 1 <br /> Owner's Phone Number 3 T' 1 11.8 I � � C <br /> Owner's Address (O 1'S / 6 6 SrA N J f <br /> Fee Simple Titleholder Name Titleholder Phone Number I I l <br /> Fee Simple Address 1 <br /> Job Address G R- (1 4460 7T 5 Th n o ri <br /> Sub Division Lot * Parcel Parcel # <br /> _ <br /> n Bio-Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Burn 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 /> n 1C.mly� 'Semi FM Other <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm FI ❑ ❑ I I n Sparklers <br /> Hood Cleaning I I ❑ ❑ ❑ I I 71 Sprinkler System Installations <br /> Hood Suppression 0 ❑ ❑ ❑ I n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> I_n Fire Works <br /> E Flammable Application- ANNUAL I ( .cJV 1 Valuation of Project <br /> F Fuel Tanks <br /> n Other: <br /> Contractor Company <br /> Signature � --'R-vC 'g.- y ■.z SeLU ri∎t -y C V ‘ Registered 2YIN I Fee Current I (Y N <br /> Address I vrf ?3 W • t c•Mbs4S\ vt Tvt._ 14aM 3Vyyr 6 I License# I <br /> ELECTRICIAN Company <br /> Signature I Registered Y/ N j Fee Current I Y/ N I <br /> Address License #. <br /> PLUMBER <br /> Company <br /> Signature Registered Y / N ,I Fee Current I Y / N J <br /> Address I I . License # I <br /> MECHANICAL Company <br /> Signature Registered Y / N ] Fee Current I Y / N 1 <br /> Address I I License # <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N J <br /> Address <br /> License # <br /> Directions: x_ r <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 />