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<br /> s�3-7 02o Cityr of Zephyrhilis Fire �ax-$�s-7so=oo2�
<br /> w:��f - Permit Application
<br /> Date Receit"d I� � �� Phone Contact for Permit �__������
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<br /> ers Addr ss � �o`Z�� �'t'• �t�'�6 1Q �.
<br /> Fee Simple Titlehol�er Neme Titleholder Phone Number � � �
<br /> Fee Simple Titieholder Address
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<br /> �o�aaa�ess �I� LQt#� ��
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<br /> Sub Division Parcel#
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<br /> �',�� Bio-Hazard Waste 5torage-ANNUAL � Fumigation Tent
<br /> (� Comm Exhaust Kitchen HoodlDuct � Hazardaus Material{Tier II or RQ Facility}ANNt3A1.
<br /> � Controlled Bum � Hood Installation
<br /> ` (� Emergency Generafor<30 kw o �PJNatural Gas-Instatlation �
<br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAI.Sale
<br /> �� Fire Protectian Maintenance-ANNIIAL � Piaces of Assembly-ANNUAI
<br /> Iry em� � t er
<br /> Sprink{er � ❑ ❑ ❑ � Ftecreationai Bum
<br /> Fire Alarm � ❑ ❑ ❑ '� � Sparklers I
<br /> Hood Gleaning � ❑ � O C� � Sprinkier Sys#em Instailations �j-,�
<br /> � Hood Suppression � ❑ ❑ ❑ C] � Standpipes(Sprinkler Sys) � �
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<br /> �{ Fire Alarm Instattation � Torch Roofingf('ar Kettte � �
<br /> ,� Fire Pumps - a Waste 7ire Storage ANNUAL
<br /> � Flammable App{ication-ANNUAL �`�� Valuation of Project .
<br /> � Fuel Tanks I
<br /> Q Other:
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<br /> Contractor �` .` / Company
<br /> Signature I� C..� .- bb >-r""'" Registered Y/N Fee Current Y/N
<br /> ress � �icense#
<br /> ELECTRICIAN ' Company
<br /> Signature Registered Y/N Fee Curreni Y/h
<br /> Address License#
<br /> PLUMBER Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address �icense#
<br /> MECHANICAL � Gompany
<br /> Signature Regisfered Y 1 N Fee Gurren# Y/N
<br /> Address License# �
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<br /> OTHER � � Company �
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address iy License# '
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<br /> D ections: _.__��_,.� _ .< < __ ��.. -
<br /> �ill out appiication completeiy �
<br /> Qwner 8�Contractar sign back of applicatian,notarized(Or,capy of signed contract with owner)
<br /> ��over$25QQ,a Notice of Commencement is required(Mechanicat wack over$5Q00)
<br /> uppiy two(2}sets of drawings with appiicabie documentation
<br /> �� Ilow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.00m)
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