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=����s^�o2o City of.Zephyrhiils Fire Fax-813-780-0021 <br /> �Permit Application <br /> Phone Contact for Pertnit �� <br /> Date Received � '� ����.�.. '� 4i,^ <br /> Owners Name "2-, � V � t �n� — 1 R-�. �� � � ers Phone Number � � ,� <br /> Owners Address <br /> Fee Simple Titleholder Name TiUeholder Phone Number ��� <br /> Fee Simple�Tideholder Address <br /> �� <br /> Job Address � C� � t � �� �-g �' �' Lot # � <br /> Sub Division Parcel # <br /> y � Bio-Hazard Waste Storage - ANNUAL � FumigaUon?ent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator < 3D kw � LPlNaturel Gas-Installation <br /> � Emergency Generetor> 30 kw � LPlNatural Gas-ANNUAL 5ale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> � emi � er �J � <br /> Sprinkler ❑ ❑ � � � Recreationai Bum � � � � <br /> Fire Alartn ❑ ❑ ❑ � � Sparklers � <br /> Hood Cleaning � ❑ ❑ ❑� a Sprinkler System Installations <br /> Hood Suppression � ❑ D ❑� � Standpipes (Sprinkler 5ys) <br /> � Fire Alartn Installation � Torch Roofingffar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> Contrector Company Pl 1�Y�E RCST�C`� O <br /> Signature Registered / N Fee Current Y/ N <br /> Address s..l� 1�1�. 1�'�l l-- 3 3 �icense # 5 � � 20� `7 <br /> ELECTRICIAN Company <br /> Signature � Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> PLUMBER Company <br /> Signature Registered Y/ N Fee Curtent Y/ N <br /> Address License # <br /> MECHANICAL 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 /> Ow�er & 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 d2wings with applicable documerrtation <br /> Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (httpJ/appraiser.pascogov.com) <br />