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� �,,e��_7ao-oo2o City of Zep yrhills Fire Fax-813-780-0021 <br /> "�°�-�� Permit A plication <br /> Date Received.� _ _�_ � ' _ Phone Contact for Permit T�`�Y� <br /> ���..—,.T,.e-._,.�_,�..,�.. � � ._._.._,_.�.,_.._-_,..__.�._..��....:..,_v�....._.__ - ... - -__�,.,�. -- - ____.___._�_ ..�.�.._...____ _�... <br /> r ����/ ���?���� <br /> �Owner's Name � �°Owner's Phone Number � � � <br /> �Owners Address i � L� � � <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> .�:.�r�._�_�__�__�� ° -- �--� - - - _...�.,-�..: -�� <br /> Job Address Lot# � <br /> Sub Division Parcel# <br /> �-.^�.._,.....a.-._......�s-=>=..t._.,���._...,.__�.-.�..R...__�_....���....�.�„__�---—�,-�:."°�~~..�.�._._.�..�__,..s,___.�.�..._..._�,.___..._�,e�_.__°__-._._._._�x�°:_--�e� <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 - 1p�J�f�/ <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale �i"�� ✓ � �� I <br /> � � � <br /> Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> try emi �n t er <br /> Sprinkler � ❑ ❑ ❑ � Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ � Sprinkler System Installations .� ,(� � ;� <br /> Hood Suppression � 0 ❑ ❑ � Standpipes(Sprinkler Sys) �J <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 /> �.- - �_.�.�_.��..._.._a....:�.�_.,..,..._�....�.�.n...._�._.___.__�...�,._..._._,..__._�,.._.._�__ �......� v�.__._.�.,.�����.,.�,b_�_..._.._._e.__._._R__�_..�__..a.....,a_....a__�_�..--� <br /> Contractor � ' Company p <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 /> c.� - �___..�....._...___.__..___...._�_..._.__-__�-__�..___,_....Y____..__�_.__.. __e._.,_.__�_..__.._e,_-.R- _..__...a,_-__�.�___.___...._.�__.v._-__-_....__..�__-- _�---.�_. <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 work over$5000) <br /> Supply two(2)sets of drawings with applicable doc�mentation <br /> Allow 10-14 days for review after submittal date. Parc I#-obtained from Property Tax Notice(http://appraiser.pascogov.com) <br />