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si Fax - 313 -780 -0021 <br /> 813=780-0020 City of Zepnyrhilfs r re= <br /> • Permit Application <br /> Date Received Phone Contact for Permit <br /> Owner's Name S TMPT,FXCR T KNELL Owner's Phone Number 813 626 15 4 8 2 <br /> Owner's Address 4701. Oak Fair Blvd TAMPA FL 33610 - <br /> Fee Simple . Titleholder Name ( - ' Titleholder Phone Number r <br /> - <br /> Fee SimpleTitleholder Address . <br /> » ;...- r =..;..�r, . -,.r , Wzr w.. ;r��v.g_�s. =-n::- ;..-"t:.•' � _ <br /> �.�.,. / 'vT: . � -:...:, ; -...� •� . .... ...-. .r � - - . .r:, -. ._::. s., w• �,....: _.. �a �... <br /> Job Address 630 Cta i %iv1 • 2P hurh tit £L , 335-1 1-FL 4 0g 71 441 2 tn4( Lot# <br /> Sub Division Parcel # <br /> »ra rois''' - .r. a-3 - • %. c.r— .,-. �.m K?•i� - hiss w .i...„:4- ..u_ ate.._._. ..rw;..Tr_..1; �rr. `;=_- ,_- „;• - - •'°:- `,�•.T. ''H'• :...- VizMw.;,. •.g-:o.CS1.,a ,...,.T �- ::7 - �•' <br /> Bio- Hazard Waste Storage - ANNUAL PI Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct I Hazards; ” -'',,; jier If or RQ Facility) ANNUAL • <br /> • Controlled Bum 1 Hood Installation <br /> I: I EmergencyGenerator < 30 kw I LP /Natural Gas - Installation <br /> Emergency Generator > 30 -kw 1 1 LP /Natural Gas - ANNUAL Sale <br /> I Fire Protection Maintenance _ ANNUAL I Places of Assembly- ANNUAL . <br /> i j (:2trly( blizi lAnl I ' Uther <br /> Sprinkler, ' V 1 ❑ . i ❑. - 1 1 Recreational Burn <br /> Fire Alarm • 1 1 ❑ ❑ ❑• - , (, 1 1 Sparklers , <br /> • <br /> - ' Hood Cleaning O . ❑ ❑ I I Sprinkler' System Installations • <br /> Hood Suppression 1 o 0 - - 0 .I I 0 Standpipes (Sprinkler Sys) .. <br /> Fire Alarm Installation i I Torch Roofing/Tar Kettle <br /> r.: Fire Pumps • • Waste Tire Storage ANNUAL <br /> I _ Fire Works , . <br /> I I• Flam inabfeApplication- ANNUAL 1 Valuation of Project <br /> I I , Fuel T . _ . <br /> Other IMIM� Z M �1��� - , . Q . A . .. r 2 . 0 ( 5 i del • <br /> a : ` - s _ •+<.:..,: - ri : o • -,+ s` ..:. - = .la` : , ° ' ..;:: ";r m a.= t .""a - v. ? � r _v,.: .,to-.' +. - ;mss - -.7T <br /> Contractor Company - r.f - / KFi,,e -i C( <br /> Signature f Registered Y / N Fee Current I' Y / N I • <br /> • Address I _. . License # I , . . I <br /> ELECTRICIAN Company , <br /> • Signature . ' Registered ;: Y 1 N : Fee Current Y / N -._I:.- <br /> •. j <br /> I , I _ ( <br /> Address I ... . .. I License # I 1 <br /> .PLUMBER . Company . <br /> Signature Registered Y / N ' I Fee Current'- Y / N e : - <br /> Address I I License # l ' <br /> MECHANICAL Company ' <br /> Signature . Registered Y / N Fee Current Y / N <br /> . Address I, .. I License # I I <br /> - <br /> OTHER - Company . <br /> Signature - Registered Y / N Fee Current Y/1\1_ <br /> Address License <br /> �cen <br /> Directions: <br /> ' . Fit[ 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 />