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;°a�a-�ao-oo2o City of Zep yrhilis Fire Fax-813-780-0021 <br /> �� � � Permit A plication <br /> Date Recei;ted � � Phone Contact for Permit�,�A� � <br /> _.�o._......__ ......�.��...•—�_��..._..._- -- — - �_..... .,4...w.. <br /> Owner's Name ' ' -f'a Owner's Phone Number �/ � � �� <br /> Owner's Address � �` L. 3c�.S'� <br />� Fee Simple Titleholder Name Titleholder Phone Number � � � <br />� Fee Simple Titleholder Address <br /> G�..a.��..,..,�.�._....v..� - ¢�-�.�.,�--v <br /> Job Address r o �j� ` � ' � L �J'3 �Z � Lot# � <br /> Sub Division Parcel# <br /> �-e,.--- - --.Y..,._s.�..a- .�.....,,�_�.� -- --�-�-y - - _�.�.,e._.�.�._.�._�_�..�..,.:�..�=—~'.y..�--'. <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 /> aEmergency 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 /> / l' C� <br /> Fire Alarm � ❑ O ❑ � � Sparklers / � l <br /> [ <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression ' � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofinglfar Kettle i i 3 � <br /> � Fire Pumps � Waste Tire Storage ANNUAL � l <br /> � Fire Works <br /> � FlammableApplication-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> ���.,._._.m..�. - _...w.. .���.�.a.� --- .. __���.,,�.._:_.._- - _.�..�_.._ __ <br /> Contractor � Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address � License# <br /> ELECTRICIAN Company <br /> Signature Registered �(/1�I 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 /> k'�_..r. -...:_�_-.-.-«.r.-..__- -�_..P.......a..�—.��.-..�..,.".._.;..._.�...__...__`....�..,_:._..,._.-.t-...: .�....uJ..�..............�,,.,�..-.�.-.e-.-.__..�..�._._.:.-._.�...r�_._.a....,.._.<,� ...,_�e�.-_..._.�..._...._-_,.. <br /> Directions: <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 /> I <br />� _ -- _ _ - <br />