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' 813-780-0020 City of Zephyrhilis Fire Fax-813-780-0021 <br /> Permit Application <br />)ate Received ��an� �.�- � Phone Contact for Permit <br /> �»,��€.�.�o-<-4:.��w..«p_ m�l rwr� �e.�c.�a�a.:w�w�+-�:��:�. �n.�� <br /> hroner's Name � kr bvw�l V(Y9u � S Owner's Phone Number � � � <br />�nmer'sAddress s6s� �ll <br />�ee Simple Titleholder Name Titleholder Phone Number � � � <br />�ee Simple Titleholder Address <br />�.�:�. .��,,: v�w+s���^�. ,,sga- <br /> . -1 �� <br /> lob Address Lot# <br /> iub Division Parcel# <br /> x �.._r^atro-_„��s�.��^-�sr_ ... _ ._ _ - - . _ .. <br /> aBio-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 /> aEmergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> a Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL i'J <br /> �y emi �n er /r �`� <br /> Sprinkler � ❑ ❑ O � � Recreational Bum � �� <br /> Fire Alarm � O ❑ ❑ � � Sparklers � <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations � <br /> Hood Suppression � ❑ � ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch RoofinglTar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: � <br />>, ,... ,_ ., _ s.:-�,r.��3'.�"�.,J�°2'"..:i:aA.i.�..^:'8�',__ _ ":'�ss,�*7`-?�3. .��' -.. 9..'"�'W:�:mKA'�-e�;�. _ . <br /> Contractor Company � ' <br /> 5ignature Registered Fee Current Y/N <br /> Address Zo /V�H�- �". /�( t�.t5 '�C 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 /> Directions: <br /> Fill out application completely <br /> Owner 8 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 />