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sis-�so-oo2o City of Zephyrhilis Fire Fax-813-780-0021 <br /> ' + PermitApplication <br /> Date Received � Phone Contact for Permit � � � <br /> Owner's Name • � Owners Phone Number � � <br /> Owner'sAddress �. � S• .�Z �e <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> .r. .. -' -.;. .::Sa M,�°C`�'..a'S".��.r:" >' � %;'��:a.^.c'+ -i �'rt,�`��'=i=.:,3.: ='�Id:K."'�,'=F'1'� •,�:.. ^°"�{g-,'�:bEiiC ..=�'t"��. ,. � - �t�:. `a�i <br /> n.-; ' . _ . �;� <br /> Job Address % (� � � („ . 3 Lot# <br /> Sub Division Parcel# <br /> -:s°-`ra�, .. x,�. , ;, . ,,, ..,��.;. <br /> �rd'v% �gt .. ..�d. qL;�l, :.`e�«i+�"A�-"»«. � .. �. �::"'k�".'e°, � ...-. . .-3..1'�_ ,:Sitt�'.: ,;�.f-,_ H � .-» - .._-�. ._ n- .- , .fi . <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/Naturai 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 /> -- - ----- - — -- - -- - - - - <br /> Sprinkler Q � � � Recreational Bum <br /> Fire Alarm ❑ ❑ ❑ � � Sparkters �� � <br /> Hood Cleaning � ❑ ❑ � � Sprinkler System Installations <br /> �� <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 �( r � ( �T <br /> Q Other� � � <br /> - z, , � . : . d. ., .. ,.}� . � � . <br /> `: <br /> Contractor " � Company <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 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 />