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s�s-�so-oo2o City of Zephyrhilis Fire Fax-813-780-0021 <br /> - . Permit Application <br /> Date Received `.- � Phone Contact for Pertnit ���� <br /> Owner's Name �, /(/ Owners Phone Number ��� <br /> Owner's Address � � (T �/ L L � C(/ � ���yy���Z c1 Fc <br /> Fee Simple Titleholder Name TiUeholder Phone Number �� � <br /> Fee Simple Titleholder Address <br /> -- ..��.;; -.• - ^-k"^:�s.'.�y,�< , �.:e=b'v`i'- A'.a . . �,._>: _ , <br /> °:� :33�f°r'>�C?"t;.9's, .�.T's.;.• r?a Y. <br /> Job Address Lot # e � <br /> Sub Division Paroel # <br /> ., .. _ .._ ....�.�.��«Y;: . e, ._ :CSF„ ..._.r �..3,�r..s.a:� ,. a , ..� ,. :.. ,. .. . .b. �a..a., ...s.nik:�:zr ..,s�...-�.. . .t.., ... , <br /> � 8t'" �::$.1.,�. <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Bum � Hood Instaliation <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 Alartn � ❑ ❑ � � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkler System installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alartn Installation � Torch RoofinglTar 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 /> . . , . v. x ... . ,. «.. r. . .. �' . . .. - � , .s.. .� � . a'Y,'.... 6:... .._...�. �,.i '.. . .w .'?z w .� .. Y: > .., <br /> Contractor Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> ELECTRICIAN Company <br /> Signature I Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> PLUMBER Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> MECHANICA Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> OTHER <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> Directions: . . . . . , . . . , . . . -. , , < .. _ .... , . , , < < . <br /> Fill out application completely <br /> Owner 8 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 drewings with applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http://appraiser.pascogov.com) <br />