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813-780-0020 City of Zephyrhilis Fire Fax-813-780-0021 <br /> • Permit Application <br /> Date Received �—� Phone Contact for Permit �_ .� <br /> Owner's Name J y�. rv5 G1,rt Owner's Phone Number ¢� ] 0 ��� � <br /> Owner's Address �� � '�/ � � �1 l` �� <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> <,:_ ,,;, ,-� �� . ,� ;�-.;,:��:�..,,�..�.-�:.�a,�� .����3�,� + ,.� . sk <br /> r :�. <br /> Job Address Y Lot# � <br /> Sub Division Parcel# <br /> n � ,, , .� .. _._.�_ „ � u,. , �� ,�� �- -�� <br /> �. . . �_,. . .� .k. z_,_ <br /> _. _..,�_ . .,e <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw a LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembiy-ANNUAL <br /> �y emi �n t er <br /> Sprinkler � � ❑ ❑ B � Recreational Bum `�/1(L� <br /> �� � C <br /> Fire Alarm ❑ ❑ l�� � Sparklers <br /> Hood Cleaning ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> Fire Works <br /> � Flammable Application-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> . ,- . , .. _. _�,..,; . __ �_.� , . � . <br /> .. ,.., ...�a ,.... .� -�..>:�. '�.::�_�,t.'a . . ..,t:..Y ......_ � .._ <br /> . � .. ...• S .�4. 4�.'.;: <br /> Contractor Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> ELECTRICIA Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> MECHANICAL Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> OTHER 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:/lappraiser.pascogov.com) <br />