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81:;- 78o -0020 <br /> City of.Zephyrhilts Fire i 1 ■ Fax -813- 780 -0021 <br /> Permit Application <br /> - Phone Contact for Permit 1 <br /> Date Received �,. _ : ..� .., �� „ , k. - � _ _ , , <br /> , <br /> Owner's Name ( i . c \ n i (1(' \ ((._ Owner's Phone Number - <br /> Owner's Address `)) ($1 STGa1on- QP�0 V- y <br /> 1 „ � `r <br /> Fee Simple Titleholder Name I I Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> Job Address <br /> I O ( Nv 6v)6 - 1---e Qh, v \(\:%\\ \ .1. T, 7 q 7..1vD I Lot# <br /> Parcel# ■ al ©0 cY�,nO Oc, <br /> Sub Division <br /> :^CYiPii -c F6'Cr2- ,f�- �Jia %,«va+. 'as..?.�.. - — 0;4•.x. a.* ,. i.�. -. �..- .,.. �;_ . ;�,�y _z <br /> Bio- Hazard Waste Storage ANNUAL n Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct I I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I Controlled Bum n Hood Installation <br /> I Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw 1 LP /Natural Gas - ANNUAL Sale <br /> ° -' Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL <br /> �� i(.ttriy1 Semi) mg tither <br /> %7 <br /> Sprinkler 1/,,, ❑ ❑ Recreational Bum <br /> Fire Alarm il/d ❑ ❑ * I 1 I I Sparklers <br /> Hood Cleaning TI ❑ ❑ ❑ I 1 I I Sprinkler System Installations <br /> Hood Suppression I1 ❑ ❑ ❑ I 1 I 1 Standpipes (Sprinkler Sys) <br /> I I Fire Alarm Installation I Torch Roofing/Tar Kettle <br /> 7 Fire Pumps I----I Waste Tire Storage ANNUAL <br /> 1 I Fire Works <br /> 7 Flammable Application- ANNUAL 1 I Valuation of Project <br /> I I Fuel Tanks <br /> n Oth: I r._ <br /> Contractor Company y I. Q, I Y a ■ • iii _ <br /> Signature �Li_ Registered yrojni Fee Current Ifitum <br /> Address I r I License # Ig Icy;0°1 I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N 1 Fee Current 1 Y/ N I <br /> Address I I License # I I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I 1 License # I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # ( I <br /> OTHER Company I <br /> Signature Registered Y / N I Fee Current I Y / N I <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 (httpj /appraiser.pascogov.com) <br />