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s��-�80-002o City of Zep yrhills Fire Fax-813-780-0021 <br /> Permit plication <br /> Date Received Phone Contact for Permit`4� � � <br /> �-----.�,..,.V._...._.._....�..�.�.._.�...�.__<__.. _�_�.,��...e...�...,.n=��`_..___u,._ �_����.e.---ro-,�.�___...,.�st..W..a..w___�. __...a � <br /> Owner's Name � �'7'� ��1Z��Dt.� � �ScO � D G� Owner's Phone Number ��?j ��a �oZ.O a <br /> Owners Address 58 S� I lS/�� S ' <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> .�,��.�..__._._,�.,���.�.. - - ��=�... - ��..s_�,�- '--='� <br /> Job Address s „Lot# + � <br /> Sub Division Parcel# <br /> s�.,.��,..�...._..�..::�r_.�_.�x,..,,:...ti,_..�.�..�,,,� _ .�..._�.M:�..____..,.....�� .4-. ._..�..����.�._.,.._._�_,.�,.._.�.e.,.�rm._..,.___.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 � LPlNatural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL �' Places of Assembly-ANNUAL <br /> try emi �n er � � 2� <br /> Sprinkler � ❑ ❑ ❑ � Recreational Bum � > <br /> Fire Alarm ❑ ❑ ❑ Sparklers �� <br /> � � <br /> Hood Cleaning � ❑ ❑ ❑ � Sprinkler System 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 /> � Flammable Application-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> ..:�_._._�.�.�._._�.:ti...�._.,..._.. ._....� __�_-.:_>_...a_e.._._n.z...._�..�.___..�__�.��_ ___....., -�-..,.�.���..�.�.._ -- -.�.P..���_.._,.__ �..��._:.�--.,r_.,���._«..-� <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.._�__..P=-...�_.,_.....__4--°___--�...__�.._a�.,�_,�.,.._.d..___�__.-__--� _ �___,._.___,._...�y,..v_�:.___._._...,.�__._._e.._..«„�.._...-.r__..��,�__.�.�--�--.-_a <br /> Directions: <br /> Fill out application completely. <br /> Owner 8�Contractor sign back of application,notarized(Or,copy of sig ed 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 />� - - — <br />