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s�3aao-oo2o City of Zep yrhills Fire Fax-813-780-0021 <br /> , Permit A plication <br /> Date Received • � d-' Phone Contact for Permit �,� � <br /> ��.�.-.^��.^._r.-..:-,.,.��___r - - - - --.�._:_...-.._.,._.._.�—,..�.Y-_.,...._...__.M_,..«........--.�,.�.�..... : — .�.=,.v,a.�...,_-��°.��.^.:z�_='-.__._....�.�- -- -- �m_.__.�. r..__. <br /> Owners Name 1 G ��"V �I � ,R�U/� Owner's Phone Number � �� ��D3 <br /> Owner's Address 1 3�2 � L p �GQ �� I�s 1-L' % G��L' �3 J �'' / <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> JobAddress �`^ S� "/� ��l S� Lot# � � <br /> Sub Division Parcel# <br /> �:.x>�.�....�,.,......,_.....-s�_b.._;,,�.._.o....��.,.�.__�,., �..�..:.�..��..,.�.__,�. .�___-_....�U. __._.�._�.T.,_,_.:..���..�.�_._�._�,<.�...-rr__a............__���....e....w,.r-�,-�-`--a <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-AMNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> tr y emi �n t er <br /> Sprinkler � ❑ ❑ ❑ � Recreational Bum � /�� <br /> l <br /> Fire Alarm � ❑ ❑ ❑ � Sparklers I <br /> Hood Cleaning � ❑ ❑ ❑ � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ • � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofinglfar Kettle <br /> � Fire Pumps � Waste Tire Storage ANN <br /> � Fire Works /'�— ��� <br /> � Flammable Application-ANNUAL / Valuation of P )@Cl �� <br /> � Fuel Tanks � ��� <br /> QOther: �--_________,______.�� I <br /> .,�:�,..�..�.. � ..���.,...s.4_..._....._�._�.._._....� ..-�.::...`�.�..;�_a_,_cd� �..n....�.e._...�..P,.........,LL....::,.�:�.--`..-:� <br /> Contractor t^ � Company ( �j � � = �N,�S <br /> Signature Registered N Fee Current /N <br /> Address 'Z D L-i� G(J �2 License# O �{' � <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 /> Si nature Registered Y/N Fee Current Y/N <br /> 9 <br /> Address License# <br /> r�--° .�,._.n�_...__�_.o...._._.�.______�__.�..�_.�_-.....-- _- - -_.�.._,..:...'..,.__;:_.�..�.�,�..�._.�.�....�..___w__,.-.�.. �..__..�...v..,�._._-----_1 <br /> Directions: '. <br /> Fill out application completely <br /> Owner 8 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 wo 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) <br />