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<br /> s�s-78o-002o City of Zephyrhi3ls Fire F�-a�3-7�o�aQz�
<br /> ' Permit Application
<br /> Qate R��ce�ved ' �'-' � �"f{ic� Phone Contact far Permif �a� ,3� _ �jo�
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<br /> �����,i= �.�.�.._.. �. - �� �� �
<br /> Owner's Name �' (,�,�..Q� Owner's Phone h7umber
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<br /> Owner's Address ,, �-eNl O '
<br /> Fee Simple Titlehold;er Name 7itleholder Phone Number �� �� C�
<br /> Fee Simple Titleholder Address
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<br /> Job Addcess� T �t(��;� �.�i.1 u� µ�-�- `.�.�,..�-�-.�;:;:� �'�� ��,S Lot#.M ��
<br /> Sub Division Parcel#
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<br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent
<br /> � Gomm Eachaust Kitohen HoodlDuct � Hazardous WEaterial(Tier 11 or RG2 Facility}ANNUA�.
<br /> � Controlled Bum Hood Installation
<br /> • Q Emergency�eneratar<30 kw �P1Natural�as-installation �
<br /> � Emergency Generator>30 kw LP/Natural Gas-ANNUAL Sale
<br /> � Fire Proteotioc�NFaintenance-ANNUAL � Places o#Assembly-ANNUAL
<br /> ry emi � t er
<br /> Sptinkler � O ❑ 0 . � Recreationa!Burn �+
<br /> � Fire Alarm � ❑ ❑ ❑ ,� � Sparklers /� „ j�C/ ��� J
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<br /> ' ^ Haod Gieaning � O D O �� � Sprinkler System Instaitations ��U ,
<br /> � ' �,�z����i��I�
<br /> � Haod Suppression � ❑ Q � � � Standpipes(Sprinkler Sys) G ,
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<br /> QFire A{arm Insta{lation � Torch RaofinglTar Ke#tle ,
<br /> � Fire Pumps � Waste Tire Storage ANNUAL �
<br /> �j Flammable App3ication-ANidUAL �_�—� Valuation of Praject . i
<br /> ; Fuel Tanks
<br /> Pl OtFi@r: �
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<br /> Contracfor �� Gampany �r'� ��'Y't�/cL +'S, �
<br /> Signature i Registered Y/N Fee Current Y/N
<br /> Address � 1 � (,t! � (} SYF1Rt' � �P� �icense# Q � �
<br /> ELECTRICIAN � Company �
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address � License#
<br /> PLUMBER � Company I
<br /> Signature Registered Y/N Fee Current Y/N I
<br /> Address � �icense#
<br /> MECHANICAL � Company �
<br /> Signature Registered Y 1 N Fee Gurrerrt Y/N
<br /> Address f�. License#
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<br /> QTHER � Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address � License# _ r
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<br /> Fill out application compietely.
<br /> Oyvner&Contractor sign back of application,notarized(Or,copy of signed contract with owner)
<br /> if over$25Q0,a Notice af Commencement is required{Mechanica{work over$500�)
<br /> S�upply two(2}sets of drawings with appticable documentatian
<br /> A�low 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com)
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