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_ ���-78o-oozo City of Zephyrhilis Fire Fax-813-780-0021
<br /> Permit Application
<br /> Date Receiv�d Phone Contact for Pertnit r a [5� 3�g
<br /> Owner's Name � . LCUJ"�. C a�IL�rn��oc�P U�F�- OwnePs Phone Number � � ��
<br /> Owner's Address �,��� 5 . ��S L rY`� �v �l((-: � � Q � � i ��L % 'C l�1 � r3 c�i t/�
<br /> r=ee 5imple Titleholder Name Titleholder Pho�e Number C-� � ��
<br /> Fee Simple Titleholder Address
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<br /> Job Address Q� UA � � � �, 2}�ILLS Lot� W C�
<br /> Sub Division Parcel� �o�Z I -OO I(� -�I L -�-?
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<br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent
<br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL
<br /> � Controlled Bum � Hood Installation
<br /> oEmergency 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
<br /> r y emi � ner
<br /> Sprink(er � ❑ ❑ �, � � Recreational Bum / (�,
<br /> Fire Alarm � p ❑ �. � � Sparklers � r �` //
<br /> Hood Cleaning � _, " ❑ � � Sprinkler 5ystem tnstaltatio�s
<br /> Hood Suppression � ❑ C ❑ � � Sfandpipes(Sprinkler Sys)
<br /> � Fire Alarm instailation � Torch Roofing/Tar Kettle
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> Flammable Application-ANNUAL
<br /> V�luation of Project
<br /> � Fuel Tanks
<br /> a Other:
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<br /> Contrector
<br /> Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address
<br /> License# �
<br /> ELECTRICIAN
<br /> Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address
<br /> License�
<br /> PLUMBER Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address �
<br /> License# �-
<br /> MECHANICAL Company
<br /> Signature Registered Y/N Fee�Current Y/N
<br /> Address � �
<br /> License�
<br /> OTHER ` , CompanY �L/� --=/�L �'�%C'�7'TV
<br /> Signature �'�, ` Registered /N Fee Current Y/N
<br /> Address License# �g 0O r �
<br /> ,, .., .,
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<br /> Directions: r �- o � � � � .. _. .. . . .
<br /> Fill out application compfetely L,�I_ [�
<br /> Owner&Contrector sign back of application,notarized(Or,copy of signed contrect 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 documentafion
<br /> Allow 1G-14 days for review after submittal date Parcel#-obta�ned from Property Tax Notice(http://appiaiser.pascogov.com)
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