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s�s-7ao-oo2o City of Ze hyrhills Fire Fax-813-780-0021
<br />' ' Permit pplication
<br /> Date Received Ph ct fo �
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<br /> ne ont ermit
<br /> Owner's Name � ��� y"��. � �(. v�L Owners Phone Number �� lf�`t p[ �j�0�
<br /> Owner's Address ���� �• IV S Vu� �, �iWD/SY�L�� `C�-•�Cyo/�(
<br /> Fee Simple Titleholder Name Titleholder Phone Number � � �
<br /> Fee Simple Titleholder Address
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<br /> �JobAddress � _ '1` �. (�,f�w��V�A` �.�, L,LJ` "1 �-�3� i �Lot#Y �
<br /> Sub Division Parcel#
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<br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent x
<br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL
<br /> � Controlled Bum � Hood Installation
<br /> � Emergency Generator<30 kw � LPlNatural Gas-Installation
<br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale
<br /> � Fire Protection Maintenance-ANNUAL � Piaces of Assembly-ANNUAL
<br /> tr y emi �n t er
<br /> Sprinkler � ❑ ❑ ❑ � Recreational Bum IP
<br /> Fire Alarm � ❑ ❑ ❑ � Sparklers �l
<br /> Hood Cleaning � �- ❑ ❑ � SprinklerSystem 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:
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<br /> Contractor Company 1�1f1�t �.. �����(, .f
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License# f7 S
<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#
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<br /> Directions:
<br /> Fiil out application completely.
<br /> Owner&Contractor sign back of application,notarized(Or,copy of si ned contract with owner)
<br /> If over$2500,a Notice of Commencement is required(Mechanical w k over$5000)
<br /> Supply two(2)sets of drawings with applicable documentation
<br /> Allow 10-14 days for review after submittal date. Parc I#-obtained from Property Tax Notice(http://appraiser.pascogov.com)
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