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' 313 =780 -0020 City of Zepnyrhilis`Fire ./�f' ; if 2,S 1 Fax- 313 -780 -0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit I <br /> Owner's Name STMPT,FXCSR TNNFLL Owner's Phone Number 813 ( 626 1 15 4 8 2 <br /> Owners Address 4701. Oak Fair Blvd TAMPA FL 33610 <br /> Fee Simple Titleholder Name • ' Titleholder Phone Number <br /> Fee SimpieTit[eholderAddress 1 <br /> ; ,, K <br /> Job Address X75) LAJ e.t \Jctttp,q �iVcL - zok,lyh•1RiS 4L U citz.. s <br /> Lot <br /> Sub Division Parcel 4 <br /> -, 7- "`:':a ..._.."rte . cam :. =ue r. mow, ..,-_ " <br /> ,�a- .v;,_�- ...�.,...�.z.. ,.,..... � ..... .e..- .... ...a,- _�.s��,.�.._.� �. - �.:.........���� �.�,^�`:�- _._:_tom:. . � , .. ,;��.:.:�=�-."'..- �Ta„` <br /> Bio- Hzard Waste Storage - ANNUAL I Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct 1 Hazardous Material (Tier If or RQ Facility) ANNUAL <br /> Controlled Bum I Hood installation <br /> F . Ernergency Generator < 30 kw 1 I . LP /Natural Gas - Installation <br /> Emergency 30 -kw LP /Natural Gas- ANNUALSale a. 1 1 <br /> I. Fire Protection Maintenance - ANNUAL I Places of Assembly- ANNUAL .. <br /> win giim IAnI j Other <br /> Sprinkler, V .. ❑ O. - i ( Recreational Bum - <br /> Fire Alarm - 1 ❑ ❑ ❑- [ , I Sparklers <br /> • <br /> ' • ' Hood Cleaning 0 ❑ - ❑ I Sprinkler System instailations • <br /> _: Hood Suppression - - .F7 0 0 -0 i ( .. .. I I ., Standpipes (Sprinkler Sys);. • <br /> Are Alarm installation " " - Torch Roofing/Tar Kettle <br /> 1 , i • Frre Pumps 1� . Waste Tire Storage ANNUAL <br /> I I Fire Works • , • ' <br /> I '• I F[amrnable Application- ANNUAL f I Valuation of Project <br /> I I . Fuel Tanks <br /> I.....i Other: 1 • <br /> E•za � = mkt– . , • . w. - � :- � : ss• - - ., -- -. .. rz _ . -.� _. -: t _� =:°rte- --n• • <br /> Contractor —` / Company A � <Ya"' � Kfn.v�- t( �- .k <br /> Signature l Registered Y / N Fee Current • Y / N I • <br /> • Address 1 - . •• . _ I, License # i • <br /> ELECTRI-;':Y Company . - . <br /> • Signature - Registered • .Y 1N : "Fee Current Y / N I r <br /> 1 1 . ( <br /> Address I License # i E <br /> .PLUMBER• :. Company <br /> Signature Registered Y / N m 1 Fee Current Y /14.'i I" - <br /> Address 1 . - - • License # - • - <br /> MECHANICAL • Company - <br /> Signature Registered Y/ N I Fee Current Y / N <br /> . Address I,:...; . ' - 1 License # I 1 <br /> OTHER - Company . <br /> Signature Registered Y / N - I Fee Current 1 Y / N <br /> Address - License # 1 <br /> - ,.: . _ - =:-...--, ,.. _ -.. =1710_ __.,R. - u.. . ..,-• - -,- - <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 4- obtained from Property Tax Notice (hftp: / /appraiser.pascogov.com) <br /> • <br />