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813 - 780 -0020 City of Zephyrhilis Fire �1' 1 f 1 ' Fax -813- 780 -0021
<br /> Permit Application ✓�' 1
<br /> Date Received l 4(2 21/0 I
<br /> P for
<br /> Phone Contact Permit j 8
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<br /> Owner's Name I � / g �j�4i C O h 1 Owner's Phone Number D f ) 77 T ( YS.CT
<br /> Owner's Address 1 3813 /'teI/y ion ct ' " / 3 (la
<br /> Fee Simple Titleholder Name K 5 Titleholder Phone Number I
<br /> Fee Simple Titleholder Address 1
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<br /> Job Address ■5ji;� jm & -- Lot # I
<br /> Sub Division Parcel #
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<br /> n Bio- Hazard Waste Storage - ANNUAL I] Fumigation Tent
<br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> FT Controlled Burn n Hood Installation
<br /> Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> i Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL / a1/4C
<br /> IQtrlyI I Semi l QM Other �J
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum JJJ C�
<br /> Fire Alarm ❑ ❑ ❑ I ( ( Sparklers t%
<br /> Hood Cleaning ❑ ❑ ❑ Sprinkler System Installations it(
<br /> Hood Suppression ❑ ❑ I ( n Standpipes (Sprinkler Sys) 1
<br /> n Fire Alarm Installation r 1 Torch Roofing/Tar Kettle CRT
<br /> El
<br /> Fire Pumps n Waste Tire Storage ANNUAL
<br /> I Fire Works
<br /> Flammable Application- ANNUAL / Q Valuation of Project
<br /> Fuel Tanks
<br /> n Other: I
<br /> ., v;. F ...+ "F- v.�M.*.,•.<;IERxr,,.,a. .:v;. „,.. .rte” .` :a MIza":"" , .•EMM . -F..
<br /> Contractor Company ,="e A A. 7 /frt e- I
<br /> Signature Registered Y / N I Fee Current I Y/ N
<br /> Address ' 0 .. D
<br /> _2 ,_ _.• , License #
<br /> ELECTRICIAN Company
<br /> Signature I Registered Y/ N I Fee Current I Y / N I
<br /> Address I I License # I
<br /> PLUMBER Company
<br /> Signature Registered Y/ N I Fee Current I Y / N,I
<br /> Address 1 I License #
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N I Fee Current Y / N I
<br /> Address 1 I License #
<br /> OTHER Company
<br /> Signature Registered Y/ N I Fee Current I Y / N
<br /> Address License #
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<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 (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)
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