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City of.Ze h rhillsFire• = .. 0/5 ID Fax - 813- 780 -0021 <br /> 813-7n-0020 tY P Y i <br /> Permit <br /> Phone mit Application Q <br /> Date Received 1 -7 -01Z 4.2 OS / 0 - Co ntactfor Permit I / S I S4$ 1 / 3s <br /> / ��y 1 /.� Owners Phone Number O /3 5 - 4 135 <br /> Owner's Name % L � S�t�C.J / � 7 7T` -'� V� � l <br /> Dwner's Address 9 O., "/ / M Tf9H I , FL 3 36 74 <br /> =ee Simple Titleholder Name Titleholder Phone Number <br /> =ee Simple Titleholder Address I _ <br /> Job Address 270n/4/0 (j P12-2 8-050 6 2./..U� Lot # <br /> Sub Division Parcel ��r, � ,,.,z • ,<.� _,� .. <br /> Bio-Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct 1. I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum I Hood Installation <br /> 1 Emergency Generator < 30 kw ' E LP/Natural Gas - Installation <br /> Emergency Generator > 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> I 1 Fire Protection Maintenance - ANNUAL I I Places of Assembly - ANNUAL <br /> IUt "yj 'semi' Frill tither <br /> Sprinkler I 1 ❑ ❑ ❑ I 1 Recreational Bum <br /> Fire Alarm I ❑ ❑ ❑ I I I I Sparklers <br /> Hood Cleaning ❑ lCd / ❑ I I I I Sprinkler System Installations <br /> Hood Suppression I I ❑ ❑ ❑ I I 1 Standpipes (Sprinkler Sys) <br /> I Fire Alarm Installation I .,I Torch Roofing/Tar Kettle <br /> I Fire Pumps I I. Waste Tire Storage ANNUAL <br /> Fire Works <br /> I Flammable Application- ANNUAL ( ( Valuation of Project <br /> I Fuel Tanks <br /> I Other: 1 �. <br /> Contractor D Company Clif/W/ 1Q.Sy -. 2?-1/ t ✓'r° Registered Y / N I Fee Current I Y / N I <br /> Address I I License # I <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N I Fee Current L Y / N <br /> Address I I License # 1 <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # 1 1 <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I 1 License # 1 <br /> OTHER Company <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address M License # �. _.. I . �....��k <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 (httpj /appraiser.pascogov.com) <br />