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r/ <br /> a�s-�so-oo2o City of Zephyrhiils Fire <br /> Fax•813J80-0021 <br /> - Permit Application <br /> Date Received �--� <br /> - . _ Phone Contact for Permit }�'�- q y z �q(�3 <br /> owner's Name � �,� / G/hl) (l f�i1l� " -- �� - �/�' �`f� �7 D <br /> Owner's Phone Number �� �—' <br /> I Q � <br /> owner'sAddress ��lt'C� iyl,��,�-I�yST�gy ��pffy,C�/flCCS �L 3�j,$��U <br /> � <br /> Fee Simple 7itleholder Name r-�} <br /> Titleholder Phone Number �� I 1 � <br /> Fee Simple Titleholder Address I__J <br /> JobAddress .77 'l. n1� T��sT ��y -;. _f��yL>/�(��S` � _y���`f�-' <br /> Lot# � <br /> Sub Dfvision -� <br /> -- _,_ Parcel# ` <br /> � Bio-Hazard Waste Storage-ANNUAL ' -� - -- ' - - - _ I <br /> � a Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> Comm Exhaust Kitchen Hood/Duct � <br /> � Hood Installation <br /> Controlled Burn a <br /> ❑ LP/Natural Gas-Installation <br /> Emergency Generator<30 kw � Lp/Natural Gas-ANNUAL Sale <br /> � Emergency Generator>30 kw a <br /> � Places of Assembly-ANNUAL <br /> Fire Protection Maintenance-ANNUAL Q <br /> � Recreational Burn <br /> try emi � er <br /> Sprinkier a ❑ ❑ � ❑ �{',�`�r/ <br /> Sparklers j `��li Y <br /> Fre Aiarm ❑ � ❑ ,- ' <br /> � � � Spr�nkter System Installations <br /> 11ood Cieaning ❑ n � � � ❑ <br /> ❑ Standpipes(Sprinkler Sys) <br /> Hood Suppression p 0 � � ❑ <br /> � Torch Roofing/Tar Kettle <br /> Fire Alarm Installation � Waste Tire Storage ANNUAL <br /> � Fire Pumps <br /> � Fve Works <br /> � Flammable Application-ANNUAL <br /> � Valuation of Project <br /> Fuel Tanks <br /> Q Other• <br /> Contractor . . . - -- - -' - - •-.- -_.�;_ -,: __ ;. , _ <br /> Signature Company A -f--°,�� �e(L�o^ � <br /> Registered L Y/� Fee Current Y/N <br /> �adress 3531 � }on <br /> License# Q g �� z <br /> cLECTRICIAN <br /> S�gnature Company � <br /> Registered i Y i i� j fee Current Y/N <br /> Address <br /> License# � <br /> PLUMSER <br /> Signature Company <br /> Registered Y i N Fee Curren4�Y/N <br /> Address <br /> License# � <br /> MECHANICAL <br /> S�gnacure Company <br /> Registered Y/N F � <br /> Address 2e Current Y/N <br /> �icense# � <br /> vTHER � <br /> =igra'ur� � Company <br /> Registered Y/N Fee Current Y/N � <br /> Address <br /> - License# r---�'� <br /> Cirect�ons. ' <br /> Fili out application rAmpletely <br /> Owner&Contractor sign back of application,notarized(Or,cupy of;:igned contract with ownerl <br /> If over 52500,a Notice of Commencement is required(Mechanical work over$5000) <br /> Supply two(2)sets of drawings with applicabie documentation <br /> Ailow 10-14 days for review after submittai date. Parcel#-obtained from Property Tax Notice{http:/iappraiser pascogov com) <br />