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sisaso-oozo City of Zephyrhilis Fire Fax-813-780-0021 <br /> _ Permit Application <br /> Date Received Phone Contact for Permit � � � <br /> Owner's Name Owners Phone Number � <br /> Owner's Address ��� �.� , . 7�jp <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> �� ' s.: - �A�.� �, ' r._� ,: <br /> JobAddress ����0 I�3( 6.�i��� �L,Cf;� •� "!, Lot# � <br /> Sub Division Parcel# <br /> � : 'l.+�e ^ ' < . -�.-� _ i'tX',: .;.�'t . �:i� ,.',�T.�w. :yA;ev_= . .,_.- ,"+a�l.=° 3.?�:� : -- '� ,.- -. ._ . <br /> s' <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Burn � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Instaliation <br /> � Emergency Generator>30 kw � LPlNatural Gas-ANNUAL Sale � <br /> � <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL {� /5�•— <br /> r y emi �n er � 1 <br /> Sprinkler � ❑ ❑ ❑ � � Recreatlonal Burn <br /> Fire Alarm ❑ ❑ ❑ � � 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 /> � FlammableApplication-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other � <br /> .,, , ., , . _. . . „-, �;$; ,�. _ ��; � , .. <br /> Contractor � � Company <br /> Signature G Registered /N Fee Current Y!N <br /> Address License# <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Curcent 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&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 />