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a�3-�so-oo2o City of Zephyrhilis Fire <br /> Fax-813-780-0021 <br /> Permit Application <br /> Date Received � / Phone Contact for Permit �, � � <br /> Owner's Name .,�C�� r d[.//,� � Owner's Phone Number � lf'� �/�� <br /> Y� <br /> O wner's A d dress 3�j�9 0 Qu � A �� " <br /> Fee Simple Titleholder Name Titleholder Phone Number �-1 �� �� <br /> Fee Simple Titleholder Address —1 <br /> Job Address D C Q�� / ��9 � �� <br /> Lot# <br /> Sub Division <br /> ,, ._ <br /> Parcel# <br /> , . _. , <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Matenal(Tier II or RQ Facility)ANNUAL <br /> � Controlled Burn � Hood Installation <br /> aEmergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> ❑� emi � er ❑ <br /> Sprinkler ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ �� � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ C� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ �� � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofinglfar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL <br /> � Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> � - � .�� � <br /> . 5 ,. r: ., .. <br /> Contractor � - <br /> Company <br /> Signature '� Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> ELECTRICIAN <br /> Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> PLUMBER <br /> Company <br /> Signature Registered Y/I�) Fee Current Y/N <br /> Address <br /> License# <br /> MECHANICAL <br /> Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> OTHER <br /> Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> Directions <br /> Fill out application compietely. <br /> Owner&Contractor sign back of appiication,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 htt //a <br /> ( p: ppraiser.pascogov.com) <br />