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<br />813-78Q.(l021> <br /> <br />Date Recai\l8d <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />Job Addl'llS5 <br /> <br />Sub DMilon <br /> <br /> <br />City ofZephyrhUIs'A~; " <br />Permit Application <br /> <br /> <br />Gl" c.\. <br /> <br />Fex-813-7S0-0021 <br /> <br />'I~ <br /> <br />,- <br /> <br /> <br />I R~.;~~~e_~r <br /> <br />Fee SImple TfUeholder Name I <br />rea Simple Titleholder Address '1 <br /> <br />- ~- <br /> <br />Phorie Contactfcr Permt <br /> <br /> <br />~~- <br />2. =- H r _. li > <br />11ltIeholder Phone Number <br /> <br />j~IJ ;~;~~: I~ lll~ I <br />I II II I <br />I <br />~. <br /> <br />, <br />I <br /> <br />.--., <br /> <br />- <br /> <br />Lot # <br /> <br />./ <br /> <br />o Bio-Hazard Waste Storage -,ANNUAL <br /> <br />Q-, Comm ExhlIuLStKilchen HoodJDuct <br />D OorMJIIed Bwn <br />Cl <br />D <br />D <br /> <br />Emergency Generatar < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protecffon Malnten1!1nce - ANNUAL <br /> <br />Sprlnlder <br />Fire Alarm <br /> <br />Hood Cleaning <br /> <br />Heod S~pression <br />D Rre A1ann'lnstallatlon <br />fire Pumps <br />Ere Worb <br />B __--UAt <br /> <br />B Fuel Tanks <br />o Other: I <br /> <br />.=:~r !. \0} ~ <br /> <br />Address ,_ <br /> <br />~=W.Nr <br /> <br />Address I <br /> <br />PLUMBER I <br />Slgnature <br />Address l <br />MECHAN/CALl <br />SIg1lll.ture <br />Address I <br /> <br />I <br /> <br />OTHER <br />Signature <br /> <br />Address I <br /> <br />DIrectlons: -- <br /> <br />Parcel # <br /> <br />] <br /> <br />... <br /> <br />FumlgB.1lan Tent <br />Hazardoull Material (TIer /1 or RQ Fscilly) ANNUAL <br />Hood InIrtll.Uation <br />LPlNIltural Gsa-lnstBllallon <br />LPJNaturaI Gas-ANNUAL. Sal& <br />P1acBS of Assembly-ANNUAL <br /> <br />Racraatlonal Bwn <br /> <br /> <br />Sparklers <br /> <br />Sprinlder'System Installations ' <br /> <br />Standpipes (Sprlnkl&r Sys) <br />Torch Roaf\ngITar KetIIe <br />Wale Tire Stonsge ANNUAL <br /> <br />,~ Valuation of Project <br /> <br />-- <br /> <br />I <br />I <br />f <br />I <br />I <br />I <br />I <br />I <br /> <br />_I <br /> <br />1" <br /> <br />I <br />., <br /> <br />I ~eN()f Fe~~TI/" ~/N r <br />1 I <br /> <br />= I Y/N I FeeCurrent I <br />Ueense# - I I <br /> <br />:: I Y/N I <br />Ucen98 # I I <br /> <br />= I Y/N <br />.L1eenae *' I <br />Company I <br />Regls1erlld Y I N <br />Ucense # f_ <br /> <br />Company <br />RegIstered <br /> <br />License # <br /> <br />Y/N <br /> <br />Fee Currant <br /> <br />Y/N <br /> <br />I <br /> <br />Fee Current <br /> <br />I YfN f <br />I <br /> <br />Y/N I <br />J <br /> <br />Fee Cu/Tlll1t <br /> <br />" <br /> <br />FJlI ow appllcatlDn CClfJIPleteIy. <br />Owner & Contractcr sign back of appl/cellan. notarized (<6. copy r:I signed contract with owner) <br />If over $2500. a Notice of Commencenwnt Is requrecl.(Mechanlcal work OYEII" $50(0) <br />Supply two (2) setB of drawings wIttl.ppllcabJe cklcumentlStlan . <br />Allow 10-14 daysforl'llvlew aftersubmllal date. PaIceI#- obtained from PropEI7ty Tax NotIce Chtip:/hwnlll8r.pBllCDgtIV.com) <br />