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813-7R0-0020 City of Zephyrhifis Fire Fax-813-780-002'1 <br /> Permit Application <br /> �te Received Pnori�Contati fi�cr Pa�rrtlit < 3 � ' <br /> ;�;�,..n*mvwsd�frMumvnaWa�;�r.vmakn' 91� �r�. . �nam;rceroTrB.a�r� . , <br /> �ner's Name �N s-��` .� OwnePs Phone Numtrer <br /> � �Z °ZZ� <br /> vnar's Address �U Z G'�4 L� /� pvLEU�4+� � �Pl �C(j' � C '.�3 �/ <br /> �e Si�rGi�±Titlghcidet tVarne Titieholder Phaone•Idumb9r � � � <br /> :e S�mple Titleholder Address <br /> ;•:;s.war�qn� , <br /> ib Address C� f)�l Z G A C..'�. �jJvW�rcd �C 6'�� 2(,�jGLI� /t � �3.�Y/ <br /> Ldt# <br /> �b Division Parcel# <br /> •,�,,,c�,�m. <br /> � Bio-Hazard Wgste Sinr��e-ANNUAL o FumigBtion 7etYt <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardnus iv1�'terla!(Tfer II or RQ Facfliry)ANWW�4L <br /> � Controiled Bum � Hood InstaNetion <br /> � Ettrergency Generatcst�3C kw � !..P/N�t��ral�3as=lnstailation <br /> � �mergency Genergfor 7 30 kw � LP/NaYural Gas-A�Nh1JJl�L 5ale <br /> � Fire PraYection MainYenance-,4NiJUAL � Piaces of Assembly�AWF1UAt <br /> � �m �nT t sr <br /> Sprinkler � C1 ❑ C7 � � R�nreatfonsl Bwm ���g <br /> Fire A1arm � ❑ D ❑ Sp�rklers �/' ` <br /> ood Cleanin9 � 5� �7 ❑ Sprinkler System InstaHations <br /> hicsod 9uppression � ❑ ❑ ❑ �� � 9tandpipss'(5pririkler Sys) <br /> QKire Alarm instailation � 7orCh hooflng/Tar K�ttle <br /> � Fire Pumps � Waste tire Stbr�ge I�NtwUAL <br /> Fire Works <br /> � Flammable Application-ANNUAL Valuation of Proje¢t <br /> Fuel Tanks <br /> Q Other: <br /> ���,�� . . �� <br /> Contractor <br /> �, _.._.____.._�_�_._....., <br /> Company UJ (Nj«����'� � <br /> 5ignature � Registered YLN Fee Current � <br /> d.. <br /> Address w ,.! • .� t �7 License# <br /> ELEC7RICIAN Companq <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> Licanse# <br /> PLUMBER � Comparty <br /> Signature Ragistered �f'',�,I� Fee Cwtrent Y/1!�I <br /> Address License# <br /> MECHANICAL Company <br /> Signature Registered Y/,f!�l Fee Cu►rent Y/N <br /> Address �—� License# <br /> OTHER Company <br /> Signature Reg!stered Y/N Fee�urrent `l/N <br /> Address Ucense# <br /> iFh,�uwt�awr5se,�.mw,m�:r,:�a� n� ,n,� . .u. ,m. .,. � w,n . r r. �.u�,mn��. - ;,!G�rv�a�„".um ,M,e <br /> Direct�ons� ,. . .. ..� . �, t,.,.�.,�, ,. . �ux�e-,c:.�, <br /> Fill out applicatian completely <br /> Owner&Contractor sign back of appiication,noiarized(Or,copy af signed contract wtth owner� <br /> If over$2500,a Notice of Commencement is required(Mechanfcal work over$5000) <br /> Supply two(2)sets oi drawings with appliceble documentation <br /> Allow 10-14 days for review after submittal date Parcef#-obtained from Property Tax tJotice(http:/lapprafser.pascogov.com) <br />