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s�aaeo-oo2o City of Zephyrhilis Fire " Fax-s�3aao-ooz�
<br /> �Permit Application
<br /> Date Receiied � �Q —�� — � Phone Contact for Permit ��� �p�a�
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<br /> Owner's Name �_(� , A4'��. , , Owner's Phone Number l��3 �o2oZ 7 � d d
<br /> Ovmer's Address � J��� /-���� `
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<br /> Fee Simple Titlehoi der Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address : wrNx
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<br /> Job Address � � f T� �^t�l l�-�r � Lot# �
<br /> Sub Division Pa�cel# '
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<br /> ' � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent
<br /> � Comm Exhaust Kitchen Hood/Duct � rHaiardous 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 /> I � tr y emi � er , -
<br /> � Sprinkler �' ❑ ❑;��� � Recreational Bum
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<br /> Fire Alartn ❑ � O`;� � Sparklers _}�
<br /> Hood Cleaning � ❑ ❑ ❑`� � Sprinkler System Installations �J
<br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) �
<br /> � Fire Alarm Installation , � Torch'Roofing/Tar Kettle �
<br /> � Fire Pumps ��` � 1Naste Ti�e Storage ANNUAL
<br /> � Fre Works ,
<br /> � Flammable Application-AMNUAL C� Q(�'. Valuation of Project
<br /> � Fuel Tanks -
<br /> Q Other: � �
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<br /> Conhactor � � ' ' Company � � tr;cri' �!�
<br /> Signature Registered /'M Fee�CuRent Y/N�
<br /> Address � p[ , o � �u i�2 �' License# �F a?o D 0 J l(� 02 -
<br /> ELECTRICIAN Company
<br /> Signature Registered ' �''Y/N Fee Gurrent Y/f�l
<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 I
<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 signed contract with owner)
<br /> ilf over$2500,a Notice of Commencement is required(Mechanical work 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 PropeRy Tax Notice(http://appraiser.pascogov.com)
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