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ais-�so-oo2o Ci of Ze h rhills Fire <br /> � p y Fax-813-780-002� <br /> , Permit Application <br /> Date Received _ Phone_Contact for Permit �,Y'�- 9�{ ,'Z � q Q 3 <br /> Owner's Name � 'Prtti N 1/ Owner�s Phone Number � C� � <br /> Owner's Address � {� � � S � �� � � <br /> . <br /> Fee Simple Titleholder Name � � <br /> Titleholder Phone Number <br /> Fee Simpie Titleholder Address <br /> ._,.. . t _.�..,... . -_.-, - - - _ ,_ _ <br /> Job Address 3 O p� �-� .{ � � � � , � � - - �� � - - �� <br /> Lot # <br /> Sub Divlsion <br /> Parcel # <br /> � Bio-Hazard Waste Storage - ANNUAL � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Comm Exhaust KitChen Hood/Duct � Hood Installation <br /> � Controlled Burn � LP/Natural Gas-Installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Emergency Generator> 30 kw � Places ofAssembly-ANNUAL <br /> � Fire Protect�on Ma;ntenance -ANNUAL � Recreational Burn <br /> try emi � t er ❑ j f/ .-7 `7 <br /> Sprinkler � p � � /n � � "1 <br /> ❑ Sparklers /� �'� (/ __J <br /> Fire Alarm ❑ ❑ ❑� � Spnnk�er System Instatlations <br /> Hood Cleaning � ❑ O ❑ Standpipes (Sprinkler Sys) <br /> Hood Suppression � ❑ ❑ ❑� � Torch Roofing/Tar Kettle <br /> Q Fire Alarm Installation � Waste Tire Storage ANNUAL <br /> � Fire Pumps <br /> � Fire Works <br /> � Flammable Application- ANNUAL <br /> ❑ Valuation of Project <br /> Fuel Tanks <br /> Q Other• <br /> ContraCtor . ,. -- -. :. • - - - �..,_ . ... _._ . _ , <br /> Company -�-- <br /> Signature � <br /> Registered Y/ N Fee Current Y/ N <br /> aaaress 3531 Yt �or► q 35 �g 12pp �, � <br /> License # <br /> ELECTRICIAN <br /> Signature <br /> Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # — � <br /> PLUMBER <br /> Company <br /> Signature � <br /> � Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> MECHANICAL <br /> Signature <br /> Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> license # <br /> vTHER � <br /> Sigratu�e � � Company —""----� <br /> Registered Y/ N Fee Current Y/ N <br /> Address � � <br /> License # <br /> Directions: - __ - _ � _ . _ - - <br /> Fill out application completely <br /> Owner & ContractOr Sign back of applicalion, notarizad (Or, copy of signed con;ract with owner) <br /> If over $2500, a Notice of Comm2ncement is required (Mechanical work over $5000) <br /> Supply two (2) sets of drawings with 3ppiicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax No6ce (htcp://appraiser.pascogov com) <br />