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813-780-0020 City of Zep,'�yrhilis Fire Fax-813-780-0021 Pennit A��plication Date Received �� Phone Contact for Permit � ' � � Owner's Name �' �p,�^n; C¢.y�}�.�C.� �h�,� p�,�,ner's Phone Number �(�j 78S Q�o Cj� --� Owner's Address p3C•l '� S-�-Y-��.�• Fee Simple Titleholder Name r� (� � Titleholder Phone Number L Fee Simple Titleholder Address �—•J Job Address Lot# � Sub Division , . Parcel# � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent � aComm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL � Controlled Burn � Hood Installation � Emergency Generator<30 kw � LP/Natural Gas-�nstallation � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL ❑� emi � er ❑ Sprinkler ❑ ❑ ❑ Recreational Burn / Fire Alarm X❑ ❑ ❑ ❑ �� Sparklers �'")� 7 � Hood Cleaning � p p � `� � � Sprinkler System Installations Hood Suppression � ❑ ❑ ❑ C� � Standpipes(Sprinkler Sys) � Fire Alarm Installation � Torch Roofing/Tar Kettle � Fire Pumps � Waste Tire Storage ANNUAL � Fire Works � Flammable Application-ANNUAL �� � Valuation of Project Fuel Tanks Q Other: . . ,, z Contractor ��1^RD- Company � Signature � Registered Y/N Fee Current Y/N Address 3 License# ELECTRICIAN Signature Company Registered Y/N Fee Current Y/N Address License# PLUMBER Signature Company Registered Y/N Fee Current Y/N Address License# MECHANICAL Signature Company Registered Y/N Fee Current Y/N Address License# OTHER Signature Company Registered Y/N Fee Current Y/N Address � License# �.,.^_.....—�.r..,�-�. Directions: Fill out application completely. Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner) If over$2500,a Notice of Commencement is required(Mechanical work over$5000) Supply two(2)sets of drawings with applicable documentation Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice htt //a ( p: ppraiser.pascogov.com)