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813-780-0020 CI of Ze h�rhills Fire Fax-813-780-0021 <br /> tY P <br /> i Permit Ap �lication <br /> Date Received _ Phone Contact for Permit_Y��� � <br /> �--��_-�_� ._.__ _... __...__.,._,�� __.�......-....._a�._..._._-.��_ _ _ �� <br /> Owner's Name ��" O �I Owner's Phone Number p� � �� 2.� " <br /> Owner's Address 3 1 UI f1.�r/1. " � � �� !� <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address � <br /> �.;1____�..e..__ ' _ �-m - - - - �.r_4._. -•� <br /> Job Address v Lot# �� <br /> Sub Division Parcel# <br /> �~Y..._�.�,.,._...�,.�...�.....�.��.:.a - ,�M.._.a...�.,�.-..,.......� ____:...._......a�,_...,a.. ._�.�__.__.:�.,�..�,.�_°____._�.-,_.�...- - -..s._.__.�� <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 � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> tr y emi � t er �\ <br /> Sprinkler � O ❑ ❑ � Recreational Bum /�//U <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers �`J ( <br /> 1 <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 /> �.::�:_,.�.v,:..-�-- .m........� ._..._...�,_._. .�,�.._....�, .,._._ - � - - -- <br /> Contractor �I�� J�/���' �r `�� � — ' pj � /S' Company <br /> v�' <br /> Signature Registered Y/N Fee Current Y/N <br /> Address � Q Q � �!�- (�c� �j 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� .�___�__-.�.�..,...___.._._ _._._..,___.,�...- ,�.,...v___.��,.."._...__�_..,.�.._....._._._^ ,:a__.w.._.._._....a.�..._-,_.�._. _..-..�y- •--.�-.,_�.___.._,_._._._.._.�..,.�� __.. <br /> Directians: <br /> Fill out application completely. <br /> Owner&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 /> Allow 10-14 days for review after submittal date. Parcel -obtained from Property Tax Notice(http://appraiser.pascogov.com) <br />