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e�saso-oo2o City of 2ephyrhills Fire <br /> Fax-813-780-0021 <br /> Permit Application <br /> Date Received �---� Phone Contac:t for pertnit ^�� <br /> Owner's Name � , ,. > : s . �� .,.-_�_—J . <br /> ` '� Owners Phone Number / � � � 3 ((j� '- <br /> Owner's Address ��'J J'r� ��' S i� ��, f-k,h4m V�' - <br /> � �� c " �R,. �...'�� S(e�- <br /> Fee Simple Titleholder Name �� � � <br /> Titleholder Phone Number <br /> Fee Simple TiUeholder Address <br /> Job Address C� g � � ���L�� � J � � � }.� � � � �� i.% 3� J'L�' Lot # <br /> , • y , ,__ 0 <br /> SubDivision �� }� r 1 fJr'! ",, �- c � <br /> ��S Parcel# �.J , ;a�.� `- �/'(:/1 �1.�" �%'���4�� CaJyG <br /> � Bio-Hazard Waste Storage - ANNUAL � <br /> FumigaGon Tent <br /> � Comm Exhaust Kitchen Hood/Duct a Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � ConU011ed Bum � Hood Installation <br /> � Emergency Generator < 30 kw <br /> � Emergency Generator > 30 kw � LP/Natural Gas-Installation <br /> � � LP/Natural Gas-ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL � <br /> ❑ � emi �n er i . � �J, (� � <br /> Sprinkler p � � (i <br /> � Recreational Bum �� <br /> Fire Alarm � ❑ ❑ � 1�� � gpark�ers � <br /> Hood Cleaning p � � � ❑ <br /> � Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ � Stand i <br /> � p pes (Sprinkler Sys) <br /> Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL <br /> � Valuation of Project <br /> Fuel Tanks <br /> Q Other <br /> Contractor <br /> Signature Company <br /> Registered Y/ N Fee Current Y/ N <br /> n���o�� <br /> �i....^se # <br /> ELECTRICIAN <br /> Signature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> PLUMBER <br /> Signature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # � <br /> MECHANICAL <br /> Signature Company <br /> Registered Y/ N Fee current Y/ N <br /> Address <br /> License # <br /> OTHER <br /> Signature � � /��.( f ►/L J <br /> Registered Y/ N Fee Current Y/ N J <br /> Address ( � _ � � <br /> License# ��' L3�,s ta <br /> Directions: � �,��� <br /> Fill out application completely. <br /> Owner & CoMractor sign back of appliqtion, notarized (Or, copy of signed conUad with ovmer) <br /> If over $2500, a Notice of Commencement is required (Mechaniql work pver $5000) <br /> Supply two (2) sets of drawings with applipble documentation <br /> Allow 10-14 days for review after submittal date. Parcel #- obtained irom Pro <br /> perty Tax Notice (http://appraiser.pascogov.com) <br />