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a�s-7ao-oo2o City of Zephyrhiils Fire
<br /> Fax-813-780-0021
<br /> Permit Application
<br /> Date Recewed � ��
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<br /> �� 9�iz �943
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<br /> Owner's Name �ry��9.�,� �� �. 9�� �D � ��fQ ��6
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<br /> Owner'sAddress 3`7�p(�� �/Jf�T/�.y,�-��}y �,��p������s /L %%S7'd
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<br /> Fee Simple Trtleholder Name �
<br /> Tiueholder Phone Number � � �
<br /> Fee Simple Titleholder qddress
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<br /> JobAddress 3gGo� �y��T/f�� �/��y, ��LCLS �� 33S�o - �
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<br /> Sub Divis�on
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<br /> � Bio-Hazard Waste Storage-ANNUAL � Hazardous Material(Tier II or RQ Faciliry)ANNUAL
<br /> � Comm Exhaust Kitchen Hood/Duct �
<br /> ❑ Hood installation
<br /> Controlled Burn a LP/Naturai Gas-Instaltation
<br /> � Emergency Generator�30 kw a LP/Natural Gas-ANNUAI Sale
<br /> � Emergency Generator>30 kw �
<br /> � Piaces of Assembiy-ANNUAL
<br /> fire''rofECtion Maintenance-ANNUAL �
<br /> Recreational Burn
<br /> � e�� n er
<br /> Sprinkler � � �
<br /> ❑ � Sparklers �/� ��C.1G�(-O(.t�
<br /> Ffre Alarm � � � ❑ ,,�-�
<br /> ❑ Sprmkler System Installations '_^
<br /> Hood Cleaning p p Q � ❑ ���/3/ /�
<br /> ❑ 5tandpipes(Sprinkler Sys)
<br /> Hood Suppression p � � � ❑
<br /> � Torch RoofnglTar Kettle
<br /> FfreAlarm Installation �
<br /> ❑ Waste Tire Storage ANNUAI
<br /> Fire P�mps
<br /> � Fire Works
<br /> � Flammable Application-�4NNUAL �---+.�.�
<br /> � Fuel Tanks �J Valuation of Pro}ect
<br /> ❑ Other�
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<br /> Centractor ._.__- - __,_,�_..,�...-_�, �...___.. ._.�_-, : -..___., . —
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<br /> S�ynature Company -�-- �
<br /> Registered Y/N Fee Current Y/N
<br /> �adress 3531 Ih .}on
<br /> CLECTRICIAN
<br /> LiCense# Q g �,� Z
<br /> S�gnature Company
<br /> Address
<br /> Registered Y/N Fee Current Y/N
<br /> P�UMBER
<br /> License# �--
<br /> S�gnature Companv
<br /> Address
<br /> Registered Y/N Fee Current Y/N
<br /> MECHANICAL �,,, LiCe�Se#
<br /> s;gnature Company
<br /> Registered Y/N F ---�
<br /> Address ee Current Y/N
<br /> uiHcR �
<br /> license#
<br /> S�9rau�� Company
<br /> Address �---' Registered Y/N Fee Cu�rent Y/N
<br /> C��econ - _ , � : """�° :. .. .. LiCense#
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<br /> Fi1i out applicatfon Completety " " ����'� - -_ -- y'_"° - _ °
<br /> Owner&ConVactor sipn back of application,notarized�Or,copy of signed contract with owner)
<br /> It over 32500,a Notice of Commencement is required(Mechanical work over$5000)
<br /> Supply two(2)sets of drewings with appliCabie documentation
<br /> Alfow 10-14 days for review aRer submittal date
<br /> Parcei#-obtained from�roperty Tax Notice(httpJlappraiser.pascogov.com)
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