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8�3-780-0020 City of Zephyrhilis Fire Fax-813-780-0021 <br /> PeRnit Application <br /> Date Received �. � � � ' � Phone Contact for Pertnit � � � <br /> � . . .w,�S.. . ,,. .. « ....... r . . ,. .. .. � ... F ... . .,.. _ . . . . . <br /> Owner's Name ����� �% C S �✓ � 12 � Owners Phone Number ��� <br /> Owners Address <br /> Fee Simple Titleholder Name TiUeholder Phone Number �� � <br /> Fee Simple Titleholder Address <br /> � ;�,...�.�,,. :7:��°���#€�k'�.fTa""?S���t:�.�:w..,�: , �. ; w. �x ::��:,t:;,i's :?2�'�a".'����°.���:r,ai>•pc , . <br /> Job Address F � � v � � � �� Lot # � <br /> Sub Division Paroel # <br /> ° . ., � . .,.� �,c :. ,"a. r�m'�'�ax.w.<'Y�:�H�t a. ,. . . A . ^a , . ..a - gs,a.<<s�'w;k:�k;=����:�'s�:.��t....r-: :+r.�. .. .., r+ , � , <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Bum � Hood Instailation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale /. —� - ' <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> y emi �n er <br /> Sprinkler � ❑ ❑ � Recreational Bum . ��D`3 <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers �� �l <br /> Hood Cleaning �❑ ❑ ❑� � Sprinkler System Installa ns � <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) ' <br /> � Fire Alartn Installation � Torch Roofinglfar Kettle <br /> � Fire Pumps a Waste Tire Storege ANNUAL <br /> � Fire Works <br /> Flammabie Application- ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> , - ��r� , z , � . ,,.+:. :�e�as: i:rz.�'�'�:�--±?l.+ta°.�"a�'';,> ,.e .._ > . - � . , , : �n:, �„ . .� <br /> . ... '''2v % 4�?' .��'<.. �k:a�:; � . .eye' � . . <br /> Contractor Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> ELECTRICIAN Company <br /> Signature t Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> PLUMBER Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> MECHANICA Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> OTHER Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> Directions: . ... __ . .. .. � . , ..�> � . , . , > <br /> Fill out application completely. <br /> Owner 8 Contractor sign back of application, notarized (Or, copy of signed contrect with owner) <br /> If over $2500, a Notice of Commencement is required (Mechanical work over $5000) <br /> Supply two (2) sets of drewings with applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http://appraiser.pascogov.com) <br />