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813- 780 -0020 City of Lephyrhllls fire <br /> Permit Application Fax- 813 - 780 -0021 <br /> Date Received <br /> Phone Contact for Permit 1 I <br /> / Owner's Name 1 r �� " � � <br /> S/ e V G ` t t D / � 4 r/ �/ JJS .1eA ` 1 Owner's P Number 1 S/ 7 j g 3 b U <br /> `Owners Address 1 7 5 DA ) 2 V J i f � I I <br /> Fee Simple Titleholder Name I <br /> Fee Simple Titleholder Address I Titleholder Phone Number <br /> Job Address 1 <br /> / <br /> 73 5 0 Pr (3 % /Z- b A <br /> y I Lot # I <br /> I <br /> Sub Division 1 <br /> Parcel # <br /> Bio- Hazard Waste Storage - ANNUAL <br /> El n Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> El Controlled Bum <br /> Hood Installation <br /> Emergency Generator < 30 kw <br /> r LP /Natural Gas - Installation - - . . <br /> Emergency Generator> 30 kw <br /> n Fire Protection Maintenance - ANNUAL n LP /Natural Gas - ANNUAL Sal <br /> Places of Assembly -AN AL <br /> ❑ L !Semi LE, ! n Other <br /> Sprinkler ❑ ❑ ❑ <br /> ! Recreational Bum I r <br /> Fire Alarm ir. 1 I I <br /> Sparklers <br /> Hood Cleaning I ❑ 0 ❑ I I El ❑ Sprinkler System Insta lion <br /> Hood Suppression ❑ ❑ ❑ I I ❑ <br /> Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation <br /> ED Torch Roofingfrar Kettle <br /> Fire Pumps <br /> Waste Tire Storage ANNUAL <br /> Fire Works <br /> F-1 Flammable Application- ANNUAL <br /> I 1 ED Fuel Tanks Valuation of Project <br /> 1 Other. . <br /> Contractor <br /> Signature <br /> ../ <br /> Company ° <br /> Registered Y / N Fee S - �o <br /> --� e t a. — <br /> Address I or, — e Current MIZUI <br /> I License # E 2, 0 0 4 1 <br /> ELECTRICIAN I <br /> Signature I Company <br /> Address I <br /> 1 <br /> Registered Y / N Fee Current Y / N <br /> PLUMBER License # <br /> Signature I Company <br /> Address I I Registered Y / N Fee Current Y/ N <br /> MECHANICAL! License # <br /> Signature I Company <br /> Address I Registered Y/ N Fee Current Y/ N <br /> OTHER <br /> I License # <br /> Signature I Company <br /> Address I Registered Y/ N Fee Current Y/ N <br /> Directions: 1 License # <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 />