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813-780-0020 City of Zephyrhilts Fire Fax-813-780-0021 <br /> . . , Permit Application <br /> Date Received { Phone Contact for Pertnit �� � <br /> Owner's Name � Q N�r' C:os Tf� � /N3 c' C a1 Z�l� /�wners Phone Number �� 7� � ��� <br /> Owners Address S�.O � ��' S'+ Zpi h!' ) I� r 1. c .3 3� T � <br /> Fee Simple Titleholder Name �{� M�- AS ry b i�'�., Titleholder Phone Number � 3 ��� 3b �Z <br /> Fee Simple Titleholder Address <br /> � °"' � :.ri�'-> �4Y�^`f p;z sS� .aY„�1 . _ . " "sF:'x�i: ''s ; - �:.T.�:fi: �'e+c.: ';r;Fr�,.. . .. <br /> Job Address Lot # � <br /> Sub Division Parcel # <br /> < . �' v . ,:r e .,. -.> , � «,, :rs> .<_.:• - .>._ . , ..,�,•:zs -. . . ,. - . . , <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> a Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> a Controiled Bum � Hood Installation <br /> � Emergency Generator < 30 kw � LP/Naturai Gas-Installation <br /> Q Emergency Generator > 30 kw a LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> �y emi �n er � / �Q S <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum � I ( V <br /> Fire Alartn � ❑ O ❑ � � Sparklers � <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation a Torch RoofinglTar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL r Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> Contractor �,� ) Company <br /> Signature �f'�(/ � 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 /> MECHANICA 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 appiication 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 />