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813-780-OG20 City of Zephyrhilis Fire Fax-813-780-0021 -
<br /> Permit Application _
<br /> Date Rec*iv=d ~ �Q Y�'� " I y Phone Contact for Pertnit �o'Z"� .�c5`�
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<br /> Owner's Name � — / T� � Owner's Phone Number � � �
<br /> Owner's Address � '" L L � � �
<br /> Fee Simple Titlehotder Name Titleholder Phone Number � � �
<br /> Fee Simple?itleholder Address
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<br /> Job Address G �j l.n .� *n�t� L L Lot# �
<br /> Sub Division Parcel# �1 - - -C7U"
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<br /> � Bio-Hazard Waste Storege-ANNUAL � Fumigation Tenf
<br /> � Comm Exhaust Kitchen Hood/Duct , � Hazardous Material(Tier II or RQ Facility)ANNUAL
<br /> � Controlled Bum � Hood Installa6on
<br /> � Emergency Generetor<30 kw � LP/Natural Gas-Installafion
<br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale
<br /> � Fire Protection Maintenance-AIYNUAL � Places of Assembly-ANNUAL
<br /> �y emi �n er
<br /> Sprinkler � O ❑ ❑ � � Recrea5onai Bum
<br /> Fire Alartn � � ❑ ❑ � � Sparklers
<br /> Hood Cieaning � ❑ O ❑ � � Sprinkler System fnstalla6ons
<br /> Hood Suppression � ❑ � ❑ � a Standpipes(Sprinkler Sys)
<br /> � Fire Alartn Instaltation a Torch Roofing/Tar Kettle
<br /> � Fire Pumps � Waste Tire Storage ANNUAL �
<br /> Fire Works
<br /> � Flammabfe Application-ANNUAL Valuation of Project
<br /> Fuel Tanks
<br /> 0 Other:
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<br /> Contractor Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> ELECTRICIAN 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 /> Addr=ss License#
<br /> MECHANICAL Company
<br /> Signature Registered Y/N Fee CuRent Y/N
<br /> Address License#
<br /> OTHER . Company ��(_/� -.T ,- -o—c'G T
<br /> Signature � Regisfered /N Fee Current /N
<br /> Address ;j , License� � ►L^ � ► �Gb 3
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<br /> Directions:
<br /> Fill out application completely
<br /> Owner&Contractor sign back of application,notarized(Or,copy of signed contrect with owner)
<br /> tf over�2500,a Notice of Commencement is required(Mecharncal work over$5000)
<br /> Suooly two(2)sets of drewing�with applicable documentation
<br /> Allow 1G-14 days for rsview after submittal date Parcel#-obtained from Properiy Tax Notice(http./lappre�ser.pascogov.com)
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