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a13a8o-oo2a City of Zep yrhiiis Fire Fax-813-780-0021 <br /> Permit A lication . <br /> Date Rec.'�c•ed ' � � <br /> Phone Contact for Permit <br /> ���,� ._� x�>�-.,_::.�--_-.��..�,�,..r„t.,.Y�.,,���,��,.��:�..-,�.,.:•�-�..,�x��-_�w:,�.-: <br /> Ovmer's Name 1� � qwner's Phone Number 1 3 r� O �i� <br /> r�rs naaf$55 `12Z vG �� �f <br /> Fee Simpie Titleholder Name 7itleholder Phone Number C..� � � <br /> Fee Simpie TitlehoiderAddress <br /> �v'°'�,�!+.?wac� . .�,_-t"�5[Q�.- ,'.�'!�. _ ±?��st�'�:.�t•it�t'Yx�t?'w.m;, - _'�F'2°�.- .'�;v-u�*�e�.-•�xM.�+p a„ <br /> Job Address �7 (2'2� �JdfJ�'� � `� s� Lot# [� <br /> Sub t}ivisian Parce!# <br /> �+`.��%'�-a�:n�:H[ia+A9o.+t�:•%':.St��i+.,eY'';;:.9�O+T#.L"�".�'?�'�i"sa+.-..�Y�t`r;8°.cgm4$3v°o:+.:,.nr,�p..y..3... .tg_r..-a...e�.-.���: ^ �sd'.`�7'e?no;c-d6-.d.�.4.w�,6'"drm.Sz�.'p"'.".,,,4.:�ti2°z34#�r°4°��HRfRr9Nr",v=..m-"'.. `-� ._.�'a[''$k�3°�` <br /> � Bia-Hazard Waste Storage-ANNUAI Q Fumigation Tent <br /> o Comm Exhaust Kitchen Haad/Duct � Hazardous Materiai(Tier ii or RQ Faciiity)ANNUAL <br /> � Controi{ec3 Sum Q Hood tnstallation <br /> oEmergency Generator<30 kw � LP/Natural Gas-Installation <br /> oEmergency Generator>30 kw o lPlNatur.�l Gas-ANNUAI Sale / <br /> � �,y Fire Protection Maintenance-ANNUAL Q Places of Assembiy-ANNUAL a�0" <br /> �.t� y emi er <br /> Sprinkier � � �� � FZecreationai Bum �� <br /> Fire Alarm ❑ ❑ O � � Sparkiers <br /> Hood Cteaning � ❑ CI ❑ � � Sprinkler System instatlations <br /> Hood Suppression � ❑ ❑ I� � � Standpipes{Sprinkler Sys) <br /> � Fire Alarm Installatipn � Torch Roofing/Tar Kettle <br /> Q Fire Pumps � Waste Tire Starage ANNUAL <br /> � Fire Works <br /> � Flammable AgplicaGon-ANNUAL � � Valuation of Project <br /> � Fuel Tanks <br /> Q Uther: <br /> � _ _ . �,��:u._ __„.. ..,�. w_�.v:-�,a;>�.���r�_- -_.,.. .::�v_:,�:��;o�:.:�. : ,. .�1,:�;��...�-��..�.:;��._ .�:�z:����,:�:r. �.�:.:.�..�a;�--.:� <br /> Contractor Company 1c. NKL"A� 1�Y1 (P <br /> Signature �{.t�—"' Registered 1 N Fee Cu�rent Y/N <br /> Address p Q � � y`L License# 6 0 <br /> ELECTRiCiAN Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address ticense# <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Curre�t Y I N <br /> Address License# <br /> MECHANICAL Company <br /> Signature Registered Y!N Fee Curcent Y!N • <br /> Address License# <br /> OTHER Company <br /> 5ignature Registered Y/N Fee Current Y/N <br /> Address �icense# <br /> >�, , ._ .- _ . �. . ..- . . � � r , - .�_ > . .�,.. .. - _. <br /> Directions: <br /> Fiil out appiication compieteiy. <br /> Qwner&Contractor sign back of application,notarized(Or,copy of signe contract with owner) <br /> It over$25p0,a Notice of Gommencement is required(Mechanical wark er$5000) <br /> Supply two{2}sets of drawings with appiicable dacume�tation <br /> Allow 10-14 days for review after submittal date. Parcel# obtained from Property Tax Notice(http://appraiser.pascogov.com) <br />