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813-780-0020 City of Ze hyrhills Fire Fax-813-780-0021
<br /> Permit pplication
<br /> Date Received �� ��� ' `� �� �_���Y� ��� Phone Contact for Permit F��Z7��� �
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<br /> Owner's Name iG�dj/ ��,tJ �1'I li � Owner's Phone Number �� CC�C'�J L��
<br /> Owners Address � �' p ' � ��� ,� ��� � '.��f(�}�,
<br /> Fee Simple Titleholder Name Titleholder Phone Number � � �
<br /> Fee Simple Titleholder Address
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<br /> Job Address F � � Q� � Lot# �
<br /> Sub Division Parcel#
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<br /> � Bio-Hazard Waste Storage-ANNUAL � � �umigation 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 � Places of Assembly-ANNUAL
<br /> t y emi �n t er
<br /> Sprinkler � ❑ ❑ ❑ � Recreational Bum ���
<br /> Fire Alarm � ❑ ❑ ❑ � Sparklers j ' d� �
<br /> Hood Cleaning � ❑ ❑ ❑ �Sprinkler System Installations �`
<br /> Hood Suppression � ❑ ❑ ❑ � Standpipes(Sprinkler Sys) ,
<br /> � Fire Alarm Installation � Torch RoofingfTar Kettle
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> � Fire Warks
<br /> � FlammableApplication-ANNUAL f � `� Valuation of Project
<br /> � Fuel Tanks
<br /> Q Other:
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<br /> Contractor ,� � � -- Company L,� i�' / �
<br /> Signature � ,'�1�'� ,�Lrr�G`c:i�—S 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 Curre�t Y/N
<br /> Address License#
<br /> OTHER Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
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<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 Comme�cement is required(Mechanical wor over$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)
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