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<br /> ' µ 813-780-002D City of Zephythilis Fire
<br /> Fax-813-780-0021
<br /> Permit Application
<br /> Date Received �1 --r�
<br /> `�^^***^� -__=== -_ ., . ._.._ .. Phone Contact for Permd C� �
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<br /> Owner's Name �ii�QT(il�Nd G� m�A�O l2. � - �
<br /> L� Owner's Phone Number �/?j 7��' 7/�
<br /> Owner's Address ���Q ��f/ � �D?,/Q�/ � ,Ll�� �L ��5,/l J
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<br /> Fee Simple T�tleholder Name � �''�''�
<br /> Titlehotder Phone Number � L--`J
<br /> Fee Simple Titiehofder Address L��.��
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<br /> Job Address �O ��Q �i/�c�S/ Iv ,��d 3� '3�/7�LLy �L ��Cy� ��
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<br /> Sub Division Lot#
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<br /> arcel#
<br /> � BiaHazard Waste Stoxage-ANNUAL �' �Hazardous Material(Tier,li or RQ Facility)ANNUAL
<br /> � Comm Euhaust KitChen Hood/Duct
<br /> ❑ Q Hood)nstallation
<br /> ControAed Bum Q
<br /> ❑ IP/Natural Gas-Instaliation
<br /> � Emergency Generator�30 kw � LP/Naturai Gas-ANNUAL Sale
<br /> Emergency Generator:>30 kw �
<br /> Q ?la:,es�tAssemoly-ANNUAL �----�
<br /> Fire^rotection Maintenance-ANNUAL �
<br /> Recreational Burn
<br /> � emi �n er ❑
<br /> Sprinkier � � � � ��
<br /> ❑ Sparklers
<br /> Fire Alarm 0 � � ��j
<br /> � � � Sprinkier System Installati ns �J
<br /> Hood Cleaning � � � � ❑
<br /> ❑ 5tandpipes(Sprinkler gys)
<br /> Hood Suppression O O ❑ � Q
<br /> � Torch RoofinglTar Kettle '
<br /> Fire Alarm Installation �
<br /> � Waste Tire Siorage ANNUA�
<br /> Fire Pumps
<br /> � Pire Works
<br /> � Flammable Application-ANNUAL ��
<br /> � Fuel Tanks Valuation of Project
<br /> ❑ Other�
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<br /> on ractor _. .:_.,::-.:,�-..
<br /> ��=-� .. _.
<br /> Siynature Company ..�-- " �'�=�-4 �_�� -- _
<br /> Registered Y/N F n
<br /> �aaress �g3� � on ee Current Y/N
<br /> tLECTRICIAN ��cense# QZ S5�������Z �
<br /> Signature Company
<br /> Address Repistered Y/N Fee Current Y/N
<br /> Pl UMBE R ��Cense�! �
<br /> S�gnature Company
<br /> Address
<br /> Registered Y/N Fee Current Y/N
<br /> MECHANICAL License# �
<br /> Si�narure Company '—'-----�
<br /> Address Registered Y/N Fee Current Y/N
<br /> GTHER � ��cense#
<br />_�9ra<.ur� �,. Company
<br /> Registered L Y/N � Fee Current Y/ �
<br /> Address �-----.
<br /> - '- '" LiCense#
<br />��;ec;�ons: ,,__..._-r_.-_:_: ,..,��
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<br /> Fill out application�mpletely.
<br /> Owner&Contractor sign back of application,r��fiz��Or,�py of�9ned contract with owner)
<br /> If over g2500,a Notice ot Commencement is required(Mechanical work over$5000)
<br /> Supply hvo(2)sets of drawings with appllcable documentation
<br /> Allow 10-14 days for review after submittai date.
<br /> Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov com)
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