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si3aso-oo2o City of Zephyrhilis Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received ; Phone Contact for Pertnit <br /> Owner's Name t�n ri,,los' �,z ��¢ Owner's Phone Number �/3 � 77d� <br /> Owner'sAddress C� S� �-G� �L � �� � ����(S <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � <br /> Fee Simple Titleholder Address <br /> .. N-' .s�u.:S.:�"�'�Y`F's:'"r_ �$'�':1kii�� .Lv , . �.i�°.'�i�.tr. �«iY�P'v '`A��.'i"I.�„�.'-�. <br /> Job Address Lot # � <br /> Sub Division Parcel # <br /> 6 ,. ,. _ iXZb '�"'-4r"�'�EFM.K . Y.� _ I'�?.'��"r:.'�G�°'r'4" ; .SY%;°i. ..� . .,.. � , t�t"w- :&�§'� . , . _ ., . , , f <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct a Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator < 30 kw � LPlNatural Gas-Installation <br /> � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> �y emi �n er <br /> Sprinkler � ❑ ❑ ❑ � Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ � ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ � ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar 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 /> 9 �E'.e9'we'v*..+�a'#it.a:o-}T.'..�-�.':'.if%b`f.: _ _ ' .�?�fi- %'9 _ "7R. =;#."1P'.C:{E'.'� � <br /> �` <br /> Contractor Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> PLUMBER Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> OTHER Company NCvr1 ,�j �-e �� tJ�(��e <br /> Signature Registered Fee Current � N <br /> Address License # ('p �'(%d <br /> i <br /> Directions: <br /> Fill out application completely <br /> Owner & 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 />