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` 813-780-002o City of Zephyrhilis Fire <br /> Fax-813-780-OU21 <br /> Permit Application <br /> ate Received <br /> Phone Contact for Pertnit ' ( ' �� �C�U <br /> wner's Name J (.1�� �j 1 i �Ch1� �� [ '—.�J � <br /> Owners Phone Number <br /> wner's Address �' f , .� (� � •� � 2� � <br /> J <br /> �e Simple TRleholder Name � �� �� <br /> Titleholder Phone Number <br /> �e Simple Titleholder Address <br /> ib Address ��\ � � � ( �j ` i� � V <br /> � L J Lot# <br /> �b Division <br /> Parcel# <br /> � Bio-Hazard Waste Storage-ANNUAL � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Comm Exhaust Kitchen Hood/Duct � Hood Installation <br /> � Controlled Bum � LP/Naturai Gas-Installation <br /> � Emergency Generator<30 kw � �P/Natural Gas-ANNUAL Sale <br /> � Emergency Generator>30 kw � Piaces of Assembiy-ANNUAL /J�� <br /> Fire Protection Maintenance-ANNUAL � ���IN <br /> Recreational Bum � <br /> ( � �y emi � er ❑ <br /> �+��Il,o,l�\ Sprinkler � p ❑ ❑ Sparklers <br /> '-'�-(?'v <br /> �j a7/I Z Fire Alarm � ❑ ❑ ❑ � � Sprinkler System Instaliations <br /> Hood Cieaning ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> ��'3�a - • Hood Suppression p � ❑ � <br /> � ❑ Torch Roofing/Tar Kettle ' <br /> Fire Alartn Installation � Waste Tire Storage ANNUAL <br /> � Fire Pumps <br /> � Fire Works <br /> � Flammable Application-ANNUAL <br /> � Valuation of Project <br /> Fuei Tanks <br />' ❑ Other: <br /> �ntractor L . \ 1 <br /> gnature ���L� V � l. Company <br /> egistered Y/N Fee Current Y 1 N <br /> Address �, ' � <br /> License# <br /> _ECTRICIAN� <br /> gnature �� ��S Company <br /> Registered Y/N Fee CuReot Y/N <br /> Address <br /> License# �— <br /> _UMBER <br /> gnature Company <br /> Registered Y/N Fee Cutrent Y/N <br /> Address <br /> License# � � <br /> ECHANICAL <br /> gnature Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# --� <br /> THER <br /> gnature Company <br /> Registered Y/N Fee Current Y/N�— <br /> Address <br /> irections: License# <br /> Fill out appiicatio� pletely. <br /> Owner&Contrac r sig�back of application,notarized(Or,copy of signed contract with owner) <br /> If over$2500,a otice of Commencement is required(Mechanical work over$5000) <br /> Suppiy twp(2) ts of drawings witli applicable documentation <br /> Allow 10-14 ys for review after submittal date. <br /> Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com) <br /> ����� �i�r, _ 4' C1 U <br /> �� �¢: � m c�� I�;�� a���-�s S <br /> � w � P��� � <br /> �� � <br />