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sis-�so-oo2o City of Zephyrhiils Fire Fax-813-780-002
<br /> Permit Application
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<br /> Date Received � � Phorie Contact tor Permit Q�l Q I q
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<br /> Owner's Name V• � i /� Owner's Phone Number C� C� �
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<br /> Owner's Address , Cq G , /�/ � �
<br /> Fee Simple Titleholder Name Titleholder Phone Number �6 /� y� �
<br /> Fee Smple Titleholtler Address
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<br /> Job Address Lot # C�
<br /> Sub Division Parcel #
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<br /> � Bio-Hazard 4Vaste Storage - ANNUAL � Hazardous Material �er II or RQ Facility) ANNUAL
<br /> � Comm Exhaust Kitchen Hood/Duct � Hood Installation
<br /> � Controiled Burn � LP/Naturai Gas-Installation
<br /> � Emergency Generator < 30 kw � LP/Naturai Gas-ANNUAL Sale
<br /> � Emergency Generator > 30 kw a Places of Assembly-ANNUAL
<br /> � Fire Protection Maintenance • ANNUAL � Recreational Burn
<br /> ry emi � er ❑
<br /> Sprinkler � � � ❑ Sparkiers
<br /> fire Alarm � ❑ ❑ � � � Sprinkler System Installations 1( �/ � �
<br /> Hood Cieaning ❑ ❑ O Stan i �
<br /> � � � dp pes (Spnnkler Sys)
<br /> Hood Suppression � ❑ ❑ O� � 7orch Roofing/Tar Kettle
<br /> � Fire Alarm Installation a Waste Tire Storege ANNUAL
<br /> � Fire Pumps
<br /> Fire Works
<br /> � Flammable AppiicaGon- ANNUAI � Valuation of Project
<br /> � Fuel Tanks
<br /> � Other:
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<br /> Contractor COmpany '�" � � j,�' h �
<br /> Signature Registered Y/ N Fee Current Y/ N
<br /> Address 3531 l�s¢ ��nQ, j7�d, License# EFOODO y1
<br /> ELECTRICIAN Company
<br /> Signature Registered Y/ N Fee Current Y/ N
<br /> Address License #
<br /> PL'JMBER
<br /> Company
<br /> S�gr.ature Registersd Y/ N Fee Current Y/ N
<br /> Address License #
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N Fee Current Y/ f�f
<br /> Address
<br /> License #
<br /> OTHER Company �—�
<br /> Signature Registered I Y/ N I Fee Current Y/ N
<br /> Address LiCense #
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<br /> Directions: � � � — •
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<br /> Fill out appliption completely
<br /> Owner & ConVactor sign back of application, notarized (Or, copy of siyned contract with or�ner)
<br /> If over 52500, a Notice of Commencement is required (Mechanical work over 55000)
<br /> Supply Nvo (2) sets of drawings w�th applicable documentation
<br /> Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax NoGce (http://appraiser.pascogov com)
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