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at,3-�so-oo2o City of Zeph rhills Fire Fax-813-780-0021 <br /> � Permit Ap iication <br /> � � ,_, <br /> Date Received Phone Contact for Permit <br /> . a.. ..._- ��+ .�i f i�To.^Ihe.G=.�:�- "i.�s.e.:..!",-',<,a��c.,.-.�.Wl"a1'.v r.3...w�t� .rvd'!?E:L?i�4[ilR!PR+':1F"`•."-�'.^itt..r�a'-t• <br /> Owner's Name �.J ^� '� ~ ' Owner's Phone Number �3 �L.�J l 0 t� <br /> Owner's Address 3�91 ('��,�ii{�'R' � � <br /> Fee Simple Titleholder Name Titlehalder Phpne Number [� �� �.� <br /> Fee Simple Titleholder Address <br /> �:,�,;.�_,�-. ,. ,;:�����:xr � ��s�,��y. <br /> Job Address / l �� �L/ 3 T Lat# �� <br /> Sub Division Parcei# <br /> ��..���,-,,��<--. _����s��_,��:.sz����-�,�_;�,����.����K� . .r =�z�:��:.�>�,»�����.�-�,��-�«�.��,,,-..,�-�- r.;� - <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> o Comm E�chaust Kitchen Hood/Duot � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> QControlled Burn � Haod Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generatar>30 kw � lP/Natural Gas-ANNUAL 3ale <br /> � Fire Protectio�Maintenence-ANNUAL � Places of Assembly-ANNUAL <br /> r y emi er � <br /> Y � <br /> Sprinkier � ❑ ❑ � Recrea6onai Bum �a <br /> Fire Alarm � ❑ D ❑ � � Spartclers � 1� <br /> Hood Cleaning � ❑ C7 ❑ � � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> QFire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Starage ANNUAL <br /> � Fire Works <br /> � Flarnmable Applicatian-ANNUAL �-��� Valuation af Project <br /> � Fuel Tanks <br /> Q Other: <br /> s, r.Y �. -:«��... .;��_�;� �:::��,����:�.a��„.-��.:,;;� :��,�. �;r�,.�-� _.�•�r=�� -;��� . <br /> � <br /> Cantractor Company }l� �l�J <br /> Signature Registened !N Fee Current Y 1 N <br /> Address a � Er.$ u0.�. �� license# Q(3�i <br /> ELECTRICIAN Campany <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> PI.UMBER Company <br /> Signature Registered Y 1 N Fee Current Y/N <br /> Address License# <br /> MEG}iAN1CAL Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address 4icense# <br /> OTHER Campany <br /> Sigriature Registered Y/N Fee Current Y/N <br /> Address �icense# <br /> *�- _�;�:..,. �., . . ...._., , , ,� . .. ., . ._. � . .._._._ .. . .. _..., <br /> .._. ..__ , __. ..<. F , .. �, § ,. _ . <br /> Directions: <br /> Fill out application campletely <br /> Owner 8�Contractor sign back of application,notarized(Or,copy oi sign contract with owner) <br /> if over$2500,a Notice of Commencemen#is required(Mechanica{vwrk ver$5000} <br /> Supply two(2}sets of drawings with appiicabie documentation <br /> Allow 10-14 days far review after submittal date Parcel -obtained from Property Tax Notice(http://appraiser.pascogov.cam) <br />