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s�3-�so-oo2o City of Zephyrhilis Fire Fax-813-780-0021 <br /> r <br /> Permit Application <br /> Date Received Phone Contact for Permit � � �rO <br /> V <br /> Owner's Name T a �� �1M �'16 Owner's Phone Number �� yy0 N18 1 <br /> Owner'sAddress ��pOM/LI I '�e ��d 'Iv (�702, <br /> Fee Simple Titleholder Name Lor i Tcr I 1 Titleholder Phone Number �� ��(7 �$ <br /> Fee Simple Titleholder Address 2, � (,� OZ� <br /> Job Address � ' (,�r' u�e✓Qrd r h��'.5 F''� 335y I Lot# � <br /> Sub Division Parcel# <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/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale �.00 <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> r y emi � er <br /> Sprinkler � ❑ ❑ ❑ B � Recreational Burn /' I(�� (�Q c <br /> Fire Alarm � � li ` <br /> �� _.._ <br /> � � ❑ � � Sparklers Y <br /> Hood Cleaning � ❑ � ❑ � � Sprinkler System Installations �i 3� � O ��� <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle I /'�s�� <br /> � Fire Pumps � Waste Tire Storage ANNUAL � �f <br /> � Fire Works <br /> � Flammable Application-ANNUAL �--, Valuation of Project <br /> � Fuel Tanks <br /> � Other� <br /> Contractor Company � <br /> Signature Registered Y%N Fee Current Y/N <br /> Address <br /> License# <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> PLUMBER <br /> Company <br /> Signature Registered � Y/N � Fee Current Y/N <br /> Address <br /> License# <br /> MECHANICAL Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> OTHER <br /> 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 />