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813-780�020 Ci of Ze h rhills Fire <br /> H p Y Fax-813-780.0021 <br /> Permit Application <br /> Date Received � 2 5-�� Phone Contact for Pertnit �/3 �"y"96 <br /> a�.-,«,�,-,,.... ... -�aa�-.:. �a��.�.�.:.�..�er.��-�.�..r=:�.� �.��n.�.��=�:H,�K-. <br /> Owner's Name o ,�j {�`��' Owner's Phone Number �'� Zl y77 Sj�,� <br /> Oumer's Address s-3�� C / �fj L-� � ' u (l �/ <br /> Fee Simple Titlehoider Name Titleholder Phone Number � � �� <br /> Fee Simple Titleholder Address <br /> K� _,. - .,. �� _ - .���.•a�G... <br /> _, � - - �=axr.eg€> _ '� <br /> Job Address �z G�-- � <br /> Lot# <br /> Sub Division Parcel# <br /> �° � � � ,�. .,�..;..:-����-�«� � � <br /> . . „�,; �;�:��=�!a,.�:3w,..-s ..�r�s;.�s. .-� . ��-_�ze�. e��'�r-���: :�.-�rss��_.�'_+;:�:,�^�-:�.-:s,.a�s�*�:.�^°>.,;�- ..�,-w.:��*�.,3��n�?�r,. <br /> a Bio-Hazard Waste Storage-ANNUAL a Fumigation Tent <br /> a 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-Instaliation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> ❑�y emi �n er I� ///J, �j / <br /> � ❑ ��T� <br /> Sprinkler ❑ ❑ ❑ Recreational Bum � <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ p O � � Sprinkler System Installations �� /'�� �/ <br /> Hood Suppression � ❑ p � � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL <br /> aValuation of Project <br /> Fuel Tanks <br /> Q Other: <br />�. ,<�.:�. ,.....,-e �u:.�,a>-,-,�. �� ��_�,� <br /> _ ._ .. ,_��-,�,�rir�. ����.- .. � � <br /> Contractor � Com an <br /> Signature ��'�-'""'' �,c��� P y �/'< <'y4!�'�e�l�- <br /> Registered N Fee Current Y/N <br /> Address , �,7, U'lU <br /> � ��d U'C Cc l�; 3�f G 3� License# <br /> ELECTRICIAN <br /> Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> PLUMBER <br /> Signature <br /> Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> MECHANICAL <br /> 5ignature <br /> Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br />�THER <br /> iignature <br /> Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> , License# <br />)irections: <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 aker submittal date. Parcel#-obtained from Property Tax Notice(http:!lappraiser.pascogov.com) <br />