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8'I`.l-780-0020 City of Zephyrhilis Fire Fax-813-780-0021
<br /> Permit Application
<br /> Date Received Phone Contact for Pertnit
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<br /> Owner's Name ,-�/" Owners Phone Number �,� �Z 2 d Z
<br /> Owner's Address s � �f s, T �� S �
<br /> Fee Simple Titleholder Name Titleholder Phone Number � C� ��
<br /> Fee Simple Titleholder Address
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<br /> Job Address �� s h . / ! � ,3� Z Lot # ��
<br /> Sub Division Parcel #
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<br /> a Bio-Hazard Waste Storage - ANNUAL a Fumigation Tent
<br /> � Comm Exhaust Kitchen Hood/Duct a Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> a Controlled Bum � Hood Installation
<br /> � Emergency Generator < 30 kw a LP/Natural Gas-Installation
<br /> � Emergency Generator> 30 kw a LP/Natural Gas-ANNUAL Sale
<br /> � Fire Protection Maintenance - ANNUAL Places of Assembly-ANNUAL _ B �
<br /> ❑ �y emi �n er � �/`� /
<br /> Sprinkler ❑ ❑ ❑ Recreational Bum �-
<br /> Fire Alartn � ❑ ❑ ❑ � � Sparklers �
<br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations �
<br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys)
<br /> � Fire Alarm installation � Torch RoofingRar Kettle
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> � Fire Works
<br /> � Flammable Application- ANNUAL �1 Valuation of Project
<br /> � Fuel Tanks
<br /> Q Other:
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<br /> Contractor � . ,... - 4, �:y�:sr.... .... �..�.. �.��a ... . .
<br /> Company
<br /> Signature ,� �, Registered Y/ N Fee Current Y/ N
<br /> Address License #
<br /> ELECTRICIAN Company
<br /> Signature � Registered Y/ N Fee Curtent 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
<br /> Signature Registered Y/ N Fee Current Y/ N
<br /> Address License #
<br /> Directions: " " � � � •. � . ,. , . ,
<br /> Fill out application completely
<br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with ovmer)
<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)
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