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a�saso City of Zephyrh FIfB Fax-813-786-0021 <br /> Permit Application <br /> Date Received � � Phone Contact for Permit �� �� �� l� <br /> �,..;r....�:....�.�.,: •A,_. � �. ,< . .�, <br /> Owner's Name Owner's Phone Number �� � <br /> Owner's Address �� �'1 �� �J��� - V�� L 1 ��`T <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � <br /> Fee Simple Titleholder Address <br /> 4i:: ' £ac�s�x•_ �.f . .;.�?' +.i.-,a.. ,�� < ,,a�;a_',. .,tr :s:i � � <br /> Job Address Lot # � <br /> Sub Division Parcel # <br /> e� ��;,.r�ne�,���<.<F ..,..,��. .>��„ ,, ., . <, , .. _ :- . �,,. ,.,A. _>� , <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controfled Burn � Hood Installation <br /> � Emergency Generator < 30 kw � LPlNatural Gas-Installation <br /> � Emergency Generator > 30 kw � LPlNatural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL �� (�, <br /> r y emi �n er �� � <br /> Sprinkler � ❑ ❑ �L � � Recreational Burn <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood•Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � �Naste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL � Valuation of Project <br /> � Fuel Tanks <br /> � Other <br /> . rao�;s�d�.:.Rfn..ds.,..;� r:a.:�t +a a.�a;.� >n ,:a.:.;..s. a.�. � <;��� n ,.a>...ea� 8,�� .... ..> w� . .s. .: ,. . ,, s . .. <br /> Contractor Company ` <br /> Signature �G� �� Registered 1 N Fee Current Y/ N <br /> Address � � � r' License # <br /> ELECTRICIAN Company <br /> Signature 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 /> 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 /> .�wxa>s . . . � .. . ....... .... . ... . .. � • . . �' � . • .� ,e:a ��. . .. . . . . �<. , . � . . .» .. _.,.�,...,..,. ...�>1r.;�. <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. Parcel #- obtained from Property Tax Notice (http://appraiser.pascogov com) <br />