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e�3aso-oo2o City of Zeph rhills Fire Fax-813-780-0021 <br /> Permit Ap lication <br /> Date Received � / ',�d O _ Phone Contact for Permit 8�.� �7 Q� ���!�{� <br /> r--.�-_ _.-_.-_..-�_p._.__.._ _.o.a.-. .,J — _._..�____.______�..__ _ - �__.,..._.�.�__.._4.......�_.,.___ _�_ �. » �. <br /> Owner's Name <br /> � 5 r �L (4/� Owner's Phone Number �l 3 7�o� ���� <br /> Ovmer's Address 5�� I �Yt �-L ��ll �E(�!-� H �l.L 5 �l. 3 ?J S �p�-� <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> tn:-�t_..�.y.._�_.�.— - - _ - - - �._-_.�-__.�.._ <br /> JobAddressV '��. �0 7.wCrFt LL ^��✓(�' ��O�f /ZL-�ILLs �L �`�•3�'�oZ-� Lot# � <br /> Sub Division Parcel# <br /> rv���,-.__...�� -- ' - —._.�.y_ - -_--.......��..P�—�. -`���.s_._._,__.__��__._�_._n.~�—..-:�-��_.-...�._�.._...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 Burn � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> tr y emi � t er <br /> Sprinkler � ❑ ❑ ❑ � Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � 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 /> � FlammableApplication-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> �::�i___.�- - ._..�.. __.. — -- -- - __..�,.,_,;....a.__. - _ �,.,:_.�.� - :. <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 /> 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 /> t� ;.�.�..-.._...;..t._,.______�,._�.-.s=_ �.._.._.._,_.. a_.a_�.-_�- _..�z_.._..._ �.__:._.,�:.:._. �__._.__..�,.._�,_�.____---_._.._..,.�_._-�,�__._.:-_�_,_.��..�_ <br /> Directions: <br /> Fill out application completely. <br /> Owner 8 Contractor sign back of application,notarized(Or,copy of signe contract with owner) <br /> If over$2500,a Notice of Commencement is required(Mechanical work ver$5000) <br /> Supply two(2)sets of drawings with applicable documentation <br /> Aliow 10-14 days for review after submittal date. Parcel -obtained from Property Tax Notice(http://appraiser.pascogov.com) <br />