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a�a-�ao-oo2o City of Zephyrhilis Fire Fax-813-780-0021 <br /> � Permit Application <br /> � <br /> Date Received � Phone Contact for Permit <br /> ,.,a�._,_,� ,..�_.�,��:�� . „�,.� _k.� _. ,. .. .�.�;���,..,�.. .:f:�.,.. <br /> Owner's Name " i t-� Owner's Phone Number C� � �� <br /> Owner's Address `1 �3� �J� `�� � <br /> Fee Simple Titleholder Name Titleholder Phone Number C� � � <br /> Fee Simple Titleholder Address �� <br /> .�yt....-r.e^�a°�;.�;�r�;�rr:.s�,��:�-ttm�.�s,�::"��:as�r .�.�= _ � �s�-���s�=�±� _ �w-a� ->�_ ,:-�� , � <br /> Job Address Lot# � � <br /> Sub Division Parcel# <br /> - - -5.- . - .. R."^�.' -0"iv',9'� .,a _., as�. . . �r .r a ., -s 'f . 3. . ,x-. - � - , i.R k=� x;t�:�:�g+ <br /> p . � . _A. '� _ -�v. �. . _ . '4-e±. �':$i <br /> � Bio-Nazard�Waste'Storage-ANNUAL a Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct a Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency 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 /> ❑�y emi �n er <br /> Sprinkler ❑ ❑ ❑ � Recreational Bum <br /> Fire Alarm �j❑ � � � Sparklers <br /> Hood Cleaning � ❑ O ❑ � � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation a Torch Roofing/Tar 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 /> a ,r�»s �, . a- �:r_ �_,- _�a�- . _ ��<vs*�s�.�,� �e: _ <br /> Contractor � Company J'�G� d �- <br /> Signature �- " Registered Y/N Fee Current Y/N <br /> Address 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 Curtent 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 /> ► <br /> Address License# <br /> Directions: <br /> Fill out application completely <br /> Owner&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 />