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<br /> 813- 7F] -O020 City ofZephyrhilisFine, Fax -313- 780 -0021
<br /> Permit 'Application
<br /> . Received
<br /> Date - _ ._.,__...�_., s__ � ....
<br /> 4 � sue: ._.< r. s - — -
<br /> Phone Contact for Permit
<br /> ��. ~� . _ _� -
<br /> Owner's Name STMPTIFXGRTNNELL Owners Phone Number 813 I 626 I 5482
<br /> Owner's Address 4701. Oak Fair Blvd TAMPA FL 33610 .
<br /> Fee Simple ,Titleholder Name - ' Titleholder Phone Number
<br /> Fee Simple Addr ss (
<br /> ="..rx ..Y J _,t- cam f ..,
<br /> � ��'�� —•-.� � .� _ ��.ve� w liT'^. ° - �'- tY+... I �1.f ., -.t �� .. -)...f ._...�,.n <..y sa�.LC� 1 .�.r c.
<br /> •p � � _ .+t .�-.w x... ......_
<br /> Job Address 6 -1al I l `�, V4 - y ra As 1 - 335L11 f Sun I.Aea ice i C,l Let
<br /> Sub Division Parcel # �
<br /> ...?•' . •^. »=�' - °' atea.:-,. ..,p. ,;:.is.�a .." -'
<br /> - 70.- ilgEZ:_`.�
<br /> .- e ms` ter•- •r- � .•^_"'r �.v.a.., .. .... ,. ....,v .n ..s..- >..er� �`L•:'..
<br /> ..� „�.. •rGX.:.;k..... `'� .., ... � .. ......,.. K._ i- S.:.... � ..v::c€:� ».._- ..- v- .,..— s. ...L+ ,...- . - `Um,�. t,..........,.. F ....,.
<br /> • 1 •J Bio- Hazard Waste Storage - ANNUAL 1 1 Fumigation Tent
<br /> Comm Exhaust Kitchen Hood /Duct Hazardous Material (Tier If or RQ Facility) ANNUAL •
<br /> (. I • Controlled Bum ( Hood Installation
<br /> Emergency Generator < 30 kw ! ] LP /Natural Gas - Installation
<br /> Emergency Generator > 30 kw I (, LP /Natural Gas - ANNUAL Sale •
<br /> Fire Protection Maintenance _ ANNUAL ( 1 Places of Assembly ANNUAL -.
<br /> C•trly1 !Semi' Mg =II
<br /> Sprinkler, ❑ ❑ ,A . • 1 Recreational Burn
<br /> Fire Alarm , ( ❑ ❑ ❑ [ I ( Sparklers . •
<br /> •
<br /> Hood Cleaning 0 ❑ ❑ • ( ( ( SprinklerSystem Installations •
<br /> ___ . , . Hood Suppression. 1 q 0 _ ..O ( ,. _0 _ Standpipes (Sprinkler Sys) . - •
<br /> 1 .-.: : : -
<br /> _ Fire Alarm Installation l C Torch • Roofing/Tar Kettle _•... ... _ _ ...._ _ .. • [, ; 1 Fire Pumps Waste Tire Storage ANNUAL •
<br /> I Fire Works .
<br /> 1• Ftaminabfe Application- ANNUAL Valuation of Project .
<br /> (` Fuef Tanks
<br /> ( Other
<br /> •
<br /> iati . .. _.�,.� � ra...�°*.' w ' ng 6. _<._.. 7 r xi L' ,.. 3.'._ ,,. , ,11,,.,,M3 " •: .' P£"Y" •'�. `Se�..:M ` aV Mirc-<. �.._.'* " `i5• � /� �,£k&'".aeY.OY, ate.` . ."eke - gr — :' ` Mill •
<br /> Contractor Company -• 'r' - (�- . tC
<br /> Signature Registered Y / N • Fee Current ' Y / N , •
<br /> Address l 1 . . . • License # •
<br /> ELECTRICIAN Company •Signature R - Registered Y N r Fee C urrent 1 Y/ N
<br /> • Address 1 • .. ( License #
<br /> PLUMBER • ... Company
<br /> Signature Registered Y / N ( Fee Current Y 1 Nr j •
<br /> •
<br /> • Address' ( License # , ' . . (
<br /> MECHANICAL Company
<br /> Signature , Registered Y 1 N Fee Current Y / N J
<br /> . Address 1.,,,-,,, . ( License # I
<br /> •
<br /> OTHER _ - - Company • -
<br /> Signature Registered Y / N Fee Current Y / N J
<br /> Address
<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.(Mechenic.al 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 (htip:/ /appraiser.pascogov.com)
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