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sa�-�eo-oa2o Ci#y of Zephyrhilis Fire Fax-s�3asa-ao2�
<br /> Permit Application
<br /> Date Received �—�� Phone Cantact for Pertnit
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<br /> Owne�s Name .Y} 3 _'' Owners Phane htuinber �� �� ��
<br /> Owners Address () �
<br /> Fee Simple Titleholder Name Titleholder Phone Number � � �
<br /> Fee Simple'Titleholder Address '
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<br /> .rob Aaaress �ot# ��
<br /> Sub Division Parce3# �
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<br /> � Bio-Hazard Waste Storage-ANNUAI. � Fumigation Tent
<br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Materiai(Tier 1!or t2Q Faciiity}ANNUAL
<br /> � Controlled Bum - Q Haod Installation
<br /> `� � Emergency Generator<30 kw �.� LP/Naturai Gas-Installation
<br /> � Emergency Generator>30 kw Q LP/Natural Gas-ANNUAL Sale
<br /> � Fre Protection Maintenance-ANNUAL . Q P(aces of Assembly-ANNUAL
<br /> �f'rfiy emi �n er
<br /> Sprinkler � � C7 Q � � F2ecreat3onat Bum
<br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers
<br /> Hood CEeaning � � ❑ ❑ C� � Sprinkter 8ystem tnstailations
<br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys)
<br /> � Fire Atarm instailation Q Torch Raofingtfar Kettie
<br /> � Fire Pumps ,t Q Waste Tire Storage ANNUAL
<br /> � Ffammable Application-ANNiJAI �— � Valuation of Project
<br /> � Fuel Tanks
<br /> [� C)ther:
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<br /> .6'
<br /> Contractor Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address �icense# f
<br /> �LECTRICIAN Company r
<br /> 8ignature Registered Y 1 N Fee Current Y 1 N
<br /> Address License#
<br /> PIUMBER Company
<br /> Signature Registered Y/N Fee Curren# 1�/N
<br /> Address License#
<br /> MECHANICAL Company �
<br /> Signature Registered Y/Id Fee Current Y/N
<br /> Address Lieensa#
<br /> OTHER Company
<br /> Signature Registered Y!N Fes Current Y/N
<br /> Address License#
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<br /> Directions:
<br /> Fiil out appfication compietely.
<br /> Chnrcter 8 Cantractor sign back of appBcation,notarized(Or,capy of signed contract with owner)
<br /> It over$2500,a Natice af Gommencement is required{Niechanical work over$5400}
<br /> Supply two(2)sets of drawings with applicable documentation
<br /> Allaw 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(httpJ/appraiser.pascogov.com)
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