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<br /> ?313-780-0020 City of Zephyfiilis Fire Fax-813-780-0021
<br /> Permit Application
<br /> Date R:eceived " �� � Phone Contact for Permit 8 i 3 3a 1 O t7
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<br /> Owner's Name �� C I Owner's Phone Number � � 3 /�c.32 �bZ
<br /> Owner'sAddress ��D� {� ��(� �IV �e h�rk ��is � �J�' Z�q
<br /> Fee Simple Titleholder Name � Titleholder PhOne Number �� �
<br /> Fee Simple Titleholder Address (
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<br /> Job Address K` [r � 5 a[ � G"�' � Iv � Ze h�rti� ►�s� ���'2 7 1 Lot # �
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<br /> Sub Division ' Parcel #
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<br /> � Bio-Hazard Waste Storage - ANNUAL �� Fumigation Tent
<br /> � Comm Exhaust Kitchen HoodlDuct I a Hazardous Material {Tier II or RQ Facility) ANNUAL
<br /> a Controlled Bum � Hood Installation
<br /> � Emergency Generator < 30 kw ,� LP/Natural Gas-Installation
<br /> � Emergency Generator > 3Q kw i� LPlNatural Gas-ANNUAL Sale
<br /> Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL � /
<br /> ��� � � Sprinkier � � Recreationai Bum � ; � 3 3 v
<br /> � �/ �'���� Fire Alarm � � t � �� � Sparklers i �
<br /> Hood CleanlSuppression � I� Sprinkler System Installations
<br /> � Fire Alartn Installation � Standpipes (Sprinkler Sys)
<br /> � Fire Pumps � Torch Roofing
<br /> � Fire Works � Waste Tire Storage ANNUAL Y
<br /> � Flammable Application- ANNUAL -
<br /> � Fuel Tanks I Valuation of Project
<br /> Q Other: ; �
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<br /> Contractor � Q��� J��� L � Company
<br /> Signature , Registered Y/ N Fee Current Y/ N
<br /> �I��Address L � 3 � License #
<br /> ELECTRICIAN Company
<br /> Signature I Registered Y/ N Fee CuRent Y! N
<br /> Address � License #
<br /> PLUMBER i Company
<br /> Signature � Registered Y/ N Fee Current Y/ N
<br /> Address � License #
<br /> MECHANICAL � Company
<br /> Signature I Registered Y/ N Fee Current Y/ N
<br /> Address
<br /> � License #
<br /> OTHER i Company
<br /> Signature Registered Y/ N Fee Current Y/ N
<br /> Address � License #
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<br /> Directions: , . .�, , . rt„ �.>.,:,:.�.,,..�,.-�;..a,.r.,...... ,...n..,..,...._:.__._.._xw._.�.,:.��:��.��z.�. _..._....<,.
<br /> Fill out appiication completely.
<br /> Owner & Contractor sign back of application, notarized (Or, cop� of signed contract wfth .ner) y��,,, �t,C+ SyG
<br /> If over $2500, a Notice of Commencement is required (Mechani 1 work over $5000) �-' `" �.��� C�
<br /> Supply two (2) sets of drawings with applicable documentation � �'� ■""""" * ��
<br /> Allow 10-'14 days for review after submittal date. � � Q�'�[ ����a�
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