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B13-780-OQ20 City of 7_ephyrhills Fire Fax-813-780-0021 <br /> . Permit Application <br /> Date Received Phone Contact for Permit r I �� I �!� <br /> �w� •a..m,a...<._ . ,. rs «..�. ,. , ,�. � "^�r <br /> Owner's Name a �— h�1 Owner's Phone Number �l✓� � �U\�� <br /> Owner's Address � ' �'� 1� �� <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � <br /> Fee Simple Titleholder Address <br /> �S�°a;�L�k4�:E�5a£:3-:e:s,: 3 �a��a:3�...st:;-ex:s�a::°..�s&�`k'.. J. . <br /> Job Address Lot # � <br /> Sub Division Parcel # <br /> .`�i5$$'�. °t'f.� t .x.s. .. .x�a. ve . x .�x,..,,.a. . , i.. .. � t '- . ... .,.,. ... e .a ...,w. � .zY.sw, <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Burn � Hood Installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL ``%� i '7 <br /> ry emi �n er yT (D ( 6 <br /> Sprinkler � ❑ ❑ T� � � 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 � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> 0 Other <br /> , ���..�- , �, ,... ,. :�m�:;,�. •.� . � ,i;f �; :.a_..r �. .� � ,•� � . .. , ,.. . ,_..>. <br /> Contractor ��(� c � Company ' <br /> Signature �-�t'� �I' �1 �al�U 11� Registered Y/ N Fee Current Y/ N <br /> Address 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 /> ��., . . . <.. .. . ... � ,. . .,. . . . - . . . . ?s P ,_.. : .� . . . . .... ° < _ : ,. <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 />