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a�sa8o-co2o City of Zephyrhiils Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received Z —/� Phone Contact for Permit <br /> �' ����M�::.�,..x-�.�� , .r.,,-. : „x ...�-�.��..,��-�-�-��,�.- _, <br /> Owner's Name �J�" ��/7%Z-� �i✓�� Ovmer's Phone Number � � � <br /> Owners Address <br /> Fee Simple Titleholder Name Titleholder Phone Number � �� � <br /> Fee Simple Titleholder Address <br /> a� _ �a�.co= <br /> Job Address � <br /> Lot# �� <br /> Sub Division Parcel# <br /> ;.x.f,:, <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> Emengency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> ��y em� �}Cn7� er ❑ <br /> Sprinkler ❑ ❑ �� Recreational Burn <br /> Fire Alarm � � ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> aFire Alartn Installation � Toroh 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 /> .���,.t�:�� <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 /> a� <br /> Directions: `���JN���,�_ <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 />