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g��-�80-002o City ofZephyrhilis Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received Phone Contact for Pertnit ��� <br /> Owner's Name IS/ / �I E' /�$�, Owner's Phone Number ��� �� <br /> Owners Address <br /> Fee Simple Titleholder Name Titleholder Phone Number ���� <br /> Fee Simple Titleholder Address J <br /> JobAddress !/ � ��C y. ��� . tt "`� . .r . <br /> ~ ' Lot # C� <br /> Sub Division Parcel # <br /> . ,r a . , .. �,. ... �._. , <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> a Comm 6chaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator > 30 kw LP/Natural Gas-ANNUAL Sale �/ J/ /�, <br /> � Fire Protection Maintenance - ANNUAL Places of Assembly-ANNUAL (,�{� /�� 4� <br /> ❑ �y emi � er � —���.- - <br /> Sprinkler O ❑ ❑ Recreational Bum ---�'�— <br /> Fire Alarm � ❑ ❑ ❑ �� � Sparklers <br /> ❑ �—•, ❑ � I �� <br /> Hood Cleaning ❑ ❑ ❑ I � ❑ Sprinkler System Instaliations �// (,� S <br /> Hood Suppression � ❑ p p � � �� <br /> Standpipes (Sprinkler Sys) � <br /> � Fire Alartn Installation � Torch Roofing/Tar Kettle ` <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL 1� — <br /> � 1 � Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> Contrector " � " "' ' • <br /> Signature . <br /> CompanY IJ�GPI Ti�� Ci��� <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> ELECTRICIAN <br /> Company <br /> Signature � Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> PLUMBER <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> MECHANICA <br /> Signature <br /> Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> OTHER <br /> Signature <br /> Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <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. Paroel #- obtained from Property Tax Notice (http://appraiser.pascogov.com) <br />