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b.:13-780-6520 City of.Zephyrhilis Fire Fax - 813 -780 -0021 <br /> Permit Application <br /> Date Received I / 6 -moo/ Q Phone Contact for Permit <br /> ..4 =^'h? z3.A.... d�,ra�.�E a x,^,,,. xu�,w»,c.,.a.,,.«,� :w,..an�sr- awa„wa..�•...a..,....eurws�. &.u'd �& �"3° <br /> Owner's Name I 3 (j lr (O r e. 5 Owner's Phone Number I ( 3 1 I r l a 1 1 5 001 <br /> h Owner's Address � - =- ra • r_ J F . �.. _ <br /> Fee Simple Titleholder Name ! , Titleholder Phone Number I I <br /> Fee SimpleTTitleholderAddress I I <br /> :<.z•x�? E. "$.4tc'"R`§i'"i" t .S�$,_nx do t... „,'W"„z'; §�3".._.. '” .».._ .'+?`."".,'.�`�.ex .'* z;•?ffi".1"'�d:Ys"£h'''d5A1''i$#. 6��"a'�t#.r�o- ✓- `'6o-,` �.`'..�' . <br /> Job Address 1 3 (saLL e1Lvc Lot # <br /> Sub Division ~ OCth 73LO Il Cell +e r Parcel # <br /> ri :��'�:s F. 3 �a� =: �e.:� r�s�n.� „�� ��a �,�:: .v�.*� �a;,N,�,...,t�°„;•,;� °> w % ,� .��r� R.:: �n� , s � < :� - , .. , , <br /> Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct ( Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I - I Controlled Bum I Hood Installation i t <br /> I - I Emergency Generator < 30 kw r---1 LP /Natural Gas - Installation 7 <br /> I Emergency Generator> 30 kw FT LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL I] Places of Assembly- ANNUAL <br /> Qtriy Semi' tja Other <br /> Sprinkler ,�( ❑ ❑ I Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning f 7 ❑ ❑ ❑ I n Sprinkler System Installations <br /> Hood Suppression 0 ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> I Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> 7 Fire Pumps I Waste Tire Storage ANNUAL <br /> 7 Fire Works <br /> n Flammable Application- ANNUAL 1 ` S 0 O 1 Valuation of Project <br /> I Fuel Tanks <br /> P1 Other: I <br /> aat.;` > *t z �a,r,✓ ..r , _v:« ss �'. :mss^ aa� >: _ d sr: �. <br /> Contractor Ilik (-N <br /> Signature f - �'1ce.' '— i/ A ' s[•j - i4 Registered C I 11 Current I Y / N <br /> Address 0 sal?) �r. C•cd ► tv - 4 eL License # I_ QWC100 s R <br /> ELECTRICIAN Company <br /> Signature I Registered Y/ N J Fee Current 1 Y/ N I <br /> Address I 1 License # I <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I I <br /> MECHANICAL Company <br /> Signature Registered Y/ N _ Fee Current I Y/ N j <br /> Address I I License # I I <br /> OTHER Company <br /> Signature Registered Y/ N j Fee Current 1 Y/ N j <br /> Address License # <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) <br />