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813-780-0020 City of Zephyrhilis Fire Fax-813-�80-0021 <br /> Permit Application <br /> Date Received S � — Phone Contact for Permit � ,�� 7 � <br /> �,��.,:�-.Y.,,,. � .. �.�.�.�,...,a�x�.. , . , . .,., : , r ,.�;�„���.�-��_. >,#-�., < <br /> Owners Name `iV� �+ l—�it�'�� Owner's Phone Number � � � <br /> Owner's Address �Z�� ���--�� J <br /> Fee Simple Titleholder Name Titleholder Phone Number [� � � <br /> Fee Simple Titleholder Address <br /> .n: :,�.t�aras��r � r�r��::� <br /> Job Address {?'�� �� �v f� Lot# � <br /> Sub Division Parcel# <br /> ��.,. , _ <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or R(l Facility)ANNUAL <br /> � ConVolled Bum � Hood Installation /)(..��p <br /> � � ' !/� r <br /> Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale �f14�� <br /> � T <br /> Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> �y emi �n er <br /> ��5 <br /> Sprinkler � � � ❑ � Recreationai Bum � _, � �-t-- � � �� <br /> Fire Alarm � ❑ ❑ ❑ � � Sparlclers �� �,�,�c� <br /> �` ��,,, <br /> Hood Cleaning � ❑ ❑ O � � Sprinkier System Installations � 2� <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) I �� �J n ��' ` 3 <br /> Fire Alarm Installation � Toroh Roofing/Tar Kettle e�° (S�1`� <br /> 6 � <br /> F i r e P u m p s Q Waste Tire Stora ge ANNUAL � f r b �-K� <br /> � Fire Works �� <br /> � Flammable Application-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> a:> s�:�;cxrt�tc�'. - <br /> Contractor ^^�1`� Company . <br /> Signature �' 'l `�V Registered /N Fee Current Y/N <br /> Address � License# � aC' <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 F�ee Current Y/N <br /> Address License# � <br /> OTHER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> �ac�€ , _ e_ . �;.�� k � a,��+�..;;,..�: <br /> Directions: <br /> Fill out application completely <br /> Owner 8 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 />