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sis-�saoo2o City of.Zephyrhilis Fire Fax-813-780-0021 <br /> Permit Appiication <br /> Date Received f?, 2 2 / Phone Contact for Pertnit � <br /> ' �:,�,��...».:�,�.,...._.._.. <br /> Owners Name Z.�u (�( LL 'r�� � O Owners Phone Number �� � I <br /> L___ <br /> Owner'sAddress ����Q CD� �1� �£P�1��N)`,(_s <br /> Fee Simple Titleholder Name Titleholder Phone Number ��� <br /> Fee SimpleTitleholder Address <br /> �: <br /> Job Address �� �1 � Lot # � <br /> Sub Division Paroel # <br /> d � Bio-Hazard Waste Storage - ANNUAL � Fumigation?ent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazarclous Material (Tier 11 or RQ Facility) ANNUAL <br /> � Controlled Bum � Hood Installation „_ <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator> 30 kw Q LP/Natural Gas-ANNUAL Sale �!� <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL J_ �� <br /> �y emi �n er l �. (� <br /> Sprinkler � ❑ ❑ � � Recreational Bum � <br /> Fire Alartn �❑ O �� � Sparklers _ <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alartn Installation � Toroh Roofing/Tar 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 /> 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 License # <br /> MECHANICA Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> OTHER �` �' Company � Tl'�C�f7�1�L <br /> Signature y,f�t— Registered Y/ N Fee Current Y/ N <br /> Address � � z yqZLCy� + �= L f License # �� j zpn <br /> Directions: <br /> Fill out application completely. <br /> Owner & Contractor sign back of application, notar¢ed (Or, copy of signed contract with ovmer) <br /> If over $2500, a Notice of Commencement is required (Mechanical work over $5000) <br /> Supply iwo (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 />