|
813-780-0020 City Of Z@ph rhills Fire Fax-813-780-0021
<br /> • ' Permit Ap lication
<br /> Date Received , Phone Contact for Permit _�A� �
<br /> �z—r_-'°-.__..__�^-_-'°°- - - -- _ - .��_�� .� - ���a..�.._...� ..,- ---- - - ----'°-- --
<br /> Owner's Name '1`/ � O' b: (..� i f'�/ ���1 � G, Owner's Phone Number ��,� � ?7�0
<br /> Ovmer's Address 3�.�a3 d!P y'" f/� ��= �J+ /G, `,1' G r y- �1
<br /> Fee Simple Titleholder Name ��,�( � J�/2 L G-. Titleholder Phone Number � � �
<br /> Fee Simple TitleholderAddress � 30 •/I/o �� %L L ,� S �
<br /> C:...:�_�.__3.__...__ ��.�._.._.�.—�..°°.°�T---'P°^-_-.�;.:..�,:�"._._ - - - _ --___.�_�..,� -
<br /> Job Address 3 p 3�./� o� Ef �G�� �P /L.G-T� G- �3 3 5�� P� Lot# �
<br /> Sub Division Parcel# Ci �"p2�r- ���dP�J�(/p/1tv'a "00�
<br />, �h.._...e.�.�.=,..-�--.��.,vo...a.,...�...._..._._..._,,. w.__,,....��.....,.._...._ .,.�,.....�._..w. - - -w_-.-.°-b __`m�,—...�"`i'_m-.�-.,,,mP._w ---,
<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 r(_
<br /> SV
<br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations .(�_ �
<br /> f�l
<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 ot r:
<br /> t�..��_�w.._:....H..�:,�.: .....-r....._.a.."�:"- ,..._.� -- �--,�..°�`�-*-�-.•.�— .�.,:..w.,�..,n,..M...�..; - _._._�_
<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 /> r�:.� �__._,_...._..�..,�,_._.._,.� - ..... ..,.�_�..v.___..._..:_�.w.,.,�_..�.:..._��a. _...�...�...._._,_.._..m���.._.b,..___..��.,......_..__...-,._,._�.._..o.....�,:�..�_..,�.,�.-..�...,_.�.�.�,._a-,-
<br /> Directions: � � �
<br /> Fill out application completely.
<br /> Owner 8�Contractor sign back of application,notarized(Or,copy of sign d contract with owner)
<br /> tf 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 />
|