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s 813-780-0020 City of Zephyrhilis Fire <br /> Fax-813-780.0021 <br /> Permit Application <br /> Date Received 2- 17 - ZCJ 1( Phone Contact for Pertnit $13 �R (� �,' (�� <br /> Owner's Name L � (T� V1 �j' � � � <br /> Ovmers Phone Number <br /> Owner's Address �v O 3(o � r�o� /Jri J � 'j(' 3 3 S <br /> Fee Simple Titleholder Name Titleholder Phone Number C� �� � <br /> Fee Simple Titleholder Address <br /> Job Address c� O 3� �-/'�e� ��� �_ �3 S-C� Z � <br /> Lot # <br /> Sub Division <br /> Paroel # <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Euhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Installation <br /> a Emergency Generator> 30 kw a LP/Natural Gas-ANNUAL le / <br /> � Fire Protection Maintenance-ANNUAL � ��.. <br /> Places of Assembly-AN AL J/ � <br /> ❑[ r y emi �n er a / - <br /> Sprinkler ❑ ❑ ❑ Recreationai Bum <br /> Fire Alartn � ❑ ❑ ❑ � � Sparklers ) � � <br /> � ,� vT <br /> Hood Cleaning ❑ ❑ ❑�� � Sprinkler System Installatio s <br /> Hood Suppression � ❑ �( ❑ � � Standpipes (Sprinkler Sys) �`--1- <br /> � Fire Alartn Installation � Torch RoofinglTar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL ��� � <br /> Valuation of Project <br /> Fuel Tanks <br /> [� Other: <br /> Contractor ' <br /> Company /_;��_ �', <br /> - k r� � <br /> Signature � Registered Y/ N Fee Current Y/ N <br /> Address � � �v 8 d 0' L.a 3�1G 3 License # <br /> ELECTRICIAN <br /> Company <br /> Sig�ature � Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> PLUMBER <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> MECHANICA <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 /> Direc a �" ° - -� � - . . , � License # , � M � ` i — '1 <br /> t ons: , <br /> . ., <.. .<_ . . W ,�.. .. <br /> Fill out appiication completely. <br /> Owner 8 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 />