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at3-7eo-ou2o Cily of Zephyrhilis Fire • Fax-813-780-U021 <br /> , Permit Appiication <br /> Date Recelved �p1. Phone Conlact tor Permit (��.�,, � ��� �,�.�� <br /> - .... - - - - - 1-.._1S-s_.�_—.�.�-�--a-�-�--,t <br /> Owners Name � Owners Phone Number C��!,�.u J L�L.L�.J C7���' <br /> Owner's Address ` <br /> Fee Simple Titleholder iJame TiUshotder Phone Number � � r_� <br /> fee S'smpte Titleholder Addreas <br /> .. <.:.. ._ ,. ,. -- _ - - - -=-� - - <br /> - - - • -_ - <br /> _- , - - ---- .,_.,:.; <br /> :-,.. . <br /> - - = -- -- - � . ....�_ <br /> r'�jt,:_,.._•. -- ------= - -- ._-=-�----� <br /> ' �Xatin i�IQ.C�(.c�. � - <br /> � Job Address ��r�' �' t�ot# <br /> Sub Division Parcel# <br /> - - - --.- -- - --- _- - . . _ _, -- - - __------- ---- <br /> : - - - .. .....,... . <br /> '-=--._ ... ., . . . ., . _. . :,_ -: - : - _-:_:_-�. .. : . ,_ :,:r <br /> a BiaHazard Waste Storage-ANNUAL a Fumfgation Tent <br /> a Camm Exhaust Kitchen HoodlDuct � Hazardous Material(Tier II or RQ Fac+lity)ANNUAL <br /> � Controlled Bum � Nood Installation <br /> � �mergeney Generator<30 kw � LP/Natura4 Gas-Installatlon <br /> � Emergency Generator>30 kw a LP/Natural Gas-ANNUAL Sate <br /> � Fire Protection Maintenance-ANNUAI Q Places of Assembty-ANNUAI. � <br /> - -� emi � er_ -- <br /> Sprinkler � o ❑ � � Recreational Burn � / ��-��� <br /> Fire Atarm � L7 ❑ �,, � � Sparklers l <br /> Hood Cieaning � ❑ O ❑ � � Spri�kter System Instatlalions <br /> Hood Suppresston � � O � � � Standpipes(Sprinkler Sys) , <br /> QFire Adarm tnstallation � Torch Roofing/Tar KetNe <br /> Fire Pumps � Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application-ANNUAL Valuatian of ProJect <br /> aF'ue1 Tanks <br /> Q Other: <br /> ConUacior ����� �A-� �r' "�—�-� ComPa�y � �I <br /> Stgnature �vU� ✓ ftegistered Y/N Fee Current Y!id <br /> Address ,),S,(.r r � ° L(cense# <br /> ELECTRICIAN Company <br /> Signature Regisiered Y/�I Fee Current Y 1 EV <br /> Address l.icense# <br /> PLUiNBER Company <br /> 5[gnaWre Registered Y/N Fee Currenl Y/{� <br /> Address license# <br /> MECHANICAL Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> OTHER Company " <br /> 5ignature Registered Y/N Fee CuRent Y!N <br /> Address License# <br /> ,... . _...:. ,-_ .-._, ... _ . . .___ _. - . - -- . - _ . - . „ , - ,....- <br /> - - _ - ._ .._.. .. �.. .. <br /> - -= =__:�. - �- ---- - � <br /> :-:_'.- - --- ------= - <br /> DlrecUons: <br /> Fill out applicallon compietely. <br /> Owner&ConVactor sign back of appllcaUan,notarized(Or,copy of signed conUact wilh ownerj <br /> If over�2500,B Notfce of Commencement is required(Mechanicai work over$5060) <br /> Suppiy two(2j sets of drewings with applicable documentation <br /> Allow 10-74 days for raview after submtttal date. Parcei#-obtalned irom Property Tax Notice(http:!lappraiser.pascogov.com) <br />