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a�saso-oo2o City of Zephyrhilis Fire Fax-813-780-002
<br /> Permit Application
<br /> �ate Received Phone Contact for Permit �,7'� 9�I Q l q q?�
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<br /> Owner's Name � Cn �(�/4 � Owner's Phone Number gl � �6�
<br /> Owner's Address
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<br /> Fee Simple Titleholder Name Ti leholder Phone Number �� �
<br /> Fe2 Simpie Trtleholder Atldress
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<br /> Job Address 3 � G � � � � - � �J � r Lot # �
<br /> Sub Division Parcei #
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<br /> � Bio-Hazard Waste Storage - ANNUAL � Hazardous Materiai (Tier II or RQ Facility) ANNUAL
<br /> � Comm Exhaust Kitchen Hood/Duct � Hood Installation
<br /> � Controlled Burn � LP/Natural Gas-Installation
<br /> � Eme�gency Generator < 30 kw ��LP/Natural Gas-ANNUAL Sale
<br /> � Emeigency Generator> 30 kw � Places ofAssembly-ANNUAL
<br /> � r�re Frotactiuii Maintenance -ANNUA� � Recreational Burn
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<br /> Sprinkler � ❑ ❑ ❑ � � Sparklers � , j r " �
<br /> Fire Alarm �❑ ❑ �� � Sprinkler System Installations
<br /> Hood Cleaning � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys)
<br /> Hood Suppression � ❑ ❑ O� � Torch Roofing/Tar Kettie
<br /> � Fire Atarm Instalfation � Waste Tire Storage ANNUAL
<br /> Q Fire Pumps
<br /> � Fire Works
<br /> � Flammable Application- ANNUAL � Valuation of Project
<br /> Fuel Tanks
<br /> � Other:
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<br /> Contractor Company /; "T"' i � (u �'1'0�1 . {r�G
<br /> Signature Registered Y/ N Fee Current Y/ N
<br /> Address 3531 1�+¢ ��an� Ra�. License# E.FO000 �11
<br /> ELECTRICIAN Company �
<br /> Signature Registered Y/ N Fee Current Y/ N
<br /> Address
<br /> License #
<br /> PLUMBER Company -�
<br /> Signature Registered Y/ N Fee Current Y/ N
<br /> Adaress License #
<br /> MECHANICAL Company �-
<br /> Signature Registered Y/ N Fee Current Y/ N
<br /> Address
<br /> License #
<br /> OTHER Company �_
<br /> Signature Registered Y/ N Fee Current Y/ N
<br /> Address License #
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<br /> Fill out appiication completely
<br /> Owner 8 ConVactor sign back of apptication, 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 drewings with applicable documentation
<br /> Aliow 10-ta days for review after submittal date. Parcel #- obtained from Property Tax Notice (http://appraiser.pascogov com)
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