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813-780-0020 City of Zephyrhilis Fire <br /> Fax-813-780-0021 , <br /> Permit Application ' <br /> Date Received + ,3-^O4'"ZA�Z Phone Contactfor Pertnit ��3� �i �0�6 <br />. ,, �.,� _. _. _ .�.... _�_.... ...�..., �.:�:.._ . . f � ��:�,�,_._-. �.:- <br /> Owner's Name �'� �'Y� Owners Phone Number $�3 7 S� �'F� <br /> OwnersAddress �907 R�r` ��l �� 33 s�Z- <br /> Fee Simple Titleholder Name Titleholder Phone Number C� �� �� <br /> Fee Simple Titleholder Address „ x,= <br /> -�^�'� , -. ,. 7:?^�5;wr�;:.� 2��7�:-�� .����s+;:t�:�^r;'3^'°• ,:r. �t.>7;s.... ..:s.���.�;:g"c .:K.'�35" ?5+:. ��Sr'.�x?",�'�••,g~�F°. ..^;.�.e^.t•;•. . :a; <br /> Job Address Lot# � <br /> Sub Division Parael# <br /> , ., � ._..:t`.�r?F:."r',�+.f.�G;;.�aT'��i�'t'S°Ydn,p7vn'k�".4`s,$ .:2�` $<:II."'s._:"5°-',*'. ...'�•k2t°. .. ... .'Y:.,',�..c.F`g`.>3 S:%R:.r�..r"iA.�7+'�•,>,�}.YA.�'aZ$�9ar"E$An .♦ „'e.'$d&':5,d�H ... w.,.`t`cl. . e[�` 5: <br /> »'a Bio-Hazard Waste Storege-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> aControlled Bum � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> aEmergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL �- <br /> �y em� �n er � I 2 � ; � <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum � <br /> Fire Alarm � ❑ � ❑ � a Sparklers <br /> Hood Cleaning � � ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression </�� ❑ ❑ � � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Toroh Roofingffar Kettle <br /> a Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL � Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> .�;r� . ,,,. � . � _ , x ,-....x.u.a�v^.;�:•":��":,., a",-•r� , ., . ` ....., .. .. ... ,k '�;,.S.�:rr..�1s..�,'� , >M. ;'F.S�'�:�v . , <br /> Contractor Company ''NG �9.c- <br /> Signature � Registered Y/N F Gurrent Y/N <br /> Address Go d O 9 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 C:ument Y/N <br /> Address License# <br /> MECHANICA 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 /> Directions: <br /> Fill out application completely <br /> Owner&Contrector 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(httpJlappraiser.pascogov.com) <br />