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��saao-oo2o City of Zephyrhilis Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received � (� <br /> .. _ , . , , . . . . . ...� . „�£� w t _ , . , Phone Contact for Pertnit X� �---TJ. .� <br /> " . � � .� :., ;,.:. y�,: <br /> Owner's Name — G c°r �-/� ""S'� '.:-.�...; ° / L.:_G � J <br /> ✓ JJ Owners Phone Number //� <br /> L.�.L� <br /> Owner's Address O ��.c.� ��`.J /�d� T�.- �� � 3� <br /> Fee Simple Titleholder Name TiUeholder Phone Number C� C� <br /> Fee Simple Titleholder Address <br /> ,_ . ;.�,- :.�':��•� � _.�: � <br /> - .e . .r-.� � -, �- «c: s=+��� w„ - <br /> a��.�. �s :�,s~� ;�.. ,. � s, , :: � <br /> Job Address � /" / � Lot # C� <br /> Sub Division r � � � ���'�� <br /> Paroel # <br /> .. .� a�� , , - _ � _�a k. �§:r&;. ,,, `K:. ,x,a.s: <br /> � Bio-Hazard Waste Storage - ANNUAL a Fumigation Tent ¢ y h � <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Bum Hood Installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Instailation <br /> � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sa <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-AN AL � <br /> ❑ r y emi �n er � ) � � <br /> Sprinkler ❑ ❑ ❑ Recreational Bum � / � <br /> �� <br /> Fire Alarm ❑ ❑ ❑ � a Sparklers <br /> Hood Cleaning ✓� I� ❑ ❑� � Sprinkler System Inst tions <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) �--- " <br /> � Fire Alarm Installation � Toroh RoofinglTar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammabie Application- ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> .. � �.. 3=, , . . . .:at�. a: �e�:?, _ , .. : , - -. - . .. ..... .�< .. ,. ,�:e-;�,. <br /> Contractor r,� :�._ °,a. ��::.r��z ��� ,. „:-r,. _.� .. �.. • <br /> � Company <br /> Signature OL.—� Registered / N Fee Current Y/ N <br /> Address <br /> License # <br /> ELECTRICIAN <br /> Company <br /> Signature � Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> PLUMBER <br /> Signature <br /> Company <br /> Registered Y/ N Fee current Y/ N <br /> Address <br /> License # <br /> MECHANICAL <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> OTHER <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> > . _ License # "� <br /> Directions: .- °_ •�- � . . .� . <br /> Fill out application completely �' 7" � - R. <br /> Owner & 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 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 />