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813-780-0020 City of Zep yrhills Fire Fax-813-780-002� <br /> Permit A plication <br /> Date Receivecl� Phone Contact for Permit .��+�,� <br /> f�=.::.�.�-�.,..._� .�.._.�.�._ ���.°-:�-�-�°a,-.�-°�- - -- - .��,_.,. _�._.�_w...w.. - <br /> Owner's Name Owner's Phone Number � � � <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> G�..�--�-__�_,�.���.`Y'°_ " s'—'=...�'°._"..,$"".�°"`T�. - ...�'�_:�.....- -._.o..._,.,a,�_�.,_°�""'�•• �..1 <br /> Job Address ��D�v v�i I� �(���� L.� ���71��� V�-' �j✓ _I � Lot# � <br /> Sub Division Parcel# <br /> �..-...+.._,...�._�:Y.��__,._.,�d..�.. _ ...�_.,_...�._.._v.._.� w�.�'- - �...... - 4.,.�.� _---__�..�.,...._.._.._ - - -•.�°°T,:��.�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 r Places of Assembly-ANNUAL � s0° � V <br /> tr y emi �n t er <br /> Sprinkler � ❑ ❑ ❑ � Recreational Bum <br /> Fire Alarm � ❑ ❑ O � � Sparklers <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 /> � oth � <br /> �:_._�.�.� � .._.�...�. p- -- �:_....� �__ � -- - - � - �� <br /> Contractor Company '(�e�/e�J�4 �tS� <br /> Signature Registered /N Fee Current Y/1�I <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/IV <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" - -���-a.�_. ,_____�._..�.�_.._...:..�._�,.._.._.._-.�.-�..,m_..__.,..�_.�_._._.-._.�_ -�.�..._,. ____..._-,,,,r�-- _.__°-°__�.�__.._.:...A_.._T:_.,_.,._�,..-��_,..-9....,��_.._:�_�_..._ <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 />