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�' l <br /> S <br /> City ofZephyrhilleFire• Fax - 313 - 780 - 0021 <br /> 81813-78D-002 00 <br /> P Application <br /> Phone Contact for Permit <br /> yam �::�s�_�.. ..,._..,M. ... bats Received <br /> Owner's Name <br /> A G Fl t E 1 3 A f r 1 S r Owner's Phone Number <br /> Owner's Address <br /> Y417 35 C. I W /SAD <br /> Titleholder Phone Number <br /> Fee Simple Titleholder Name J <br /> Fee Simple Titleholder Address °" <br /> .... �. ":.:..: ' ., r�"x�.u 'Txur�'hWj�' . "���. %'wn°xa"'�.r+ira ^ °u • <br /> 4 35 <br /> C) -anic oPitD Lot# <br /> Jab Address <br /> Parcel # 1 <br /> Sub Division <br /> Bio- Hazard Waste Storage - ANNUAL <br /> ( � Fumigation Tent <br /> 1 I I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I 1 Comm Exhaust Kitchen Hood/Duct <br /> ,r I <br /> _ ;]/ Hood Installation <br /> - Controlled Burn I 1 <br /> LP /Natural Gas- tnstaliation <br /> 1 Emergency Generator < 30 kw � LP/Natural Gas - ANNUAL Sale <br /> Emergency Generetor> 30 kw I I Places of Assembly - ANNUAL <br /> ]ut q <br /> n Fire Protection Maintenance - ANNUAL finer !I � / 1 <br /> ny� ' }semi] f�1 1 � L.� ( - � �-• <br /> CI I Recreational Bum Sprinkler <br /> 1 1 o 0 01 I Sparklers <br /> Fire Alarm <br /> 0 ❑ 0 I I Sprinkler System Installations <br /> Hood Cleaning <br /> ❑ 0 0 ❑ I 1 Standpipes (Sprinkler Sys) 1 <br /> Hood Suppression 1 <br /> 11 I Fire Alarm Installation 1 1 Torch Roofing/Tar Kettle <br /> 1 I 1 Waste Tire Storage ANNUAL <br /> Fire Pumps <br /> 1 i Fire Works Valuation of Project <br /> 1 Flammable Application - ANNUAL <br /> :.1 1 Fuel Tanks <br /> 1 1 1 Other: 1 <br /> Company <br /> Contractor l ,/ L N I . a Q C. I� Registered [ Y/ N I Fee Current 1 Y/ N <br /> Signature I - V !i <br /> Address 1 I License # <br /> • 1 Company <br /> ELECTRICIAN Registered Y / N Fee Current L Y / N <br /> • • <br /> Signature <br /> Address 1 1 License # <br /> PLUMBER Company <br /> Registered Y / N Fee Current I Y / N <br /> Signature <br /> Address 1 I License # 1 I <br /> MECHANICAL, Company <br /> Signature <br /> MECHANICAL' Registered 1 L Y / N I Fee Current 1 Y/ N <br /> Address 1 l • License # 1 <br /> OTHER Company <br /> • <br /> Signature I Registered Y / N 1 Fee Current 1 Y/ NI <br /> Address License# <br /> _�. .... W.:�.. .. .__ <br /> Directions: <br /> Fill out application completely. <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> If over 52500, a Notice of Commencement is required .(Mechanical work over $5000) <br /> Supply two (2) sets of drawings with applicable documentation • <br /> Allow 1D days for review after submittal date. Parcel # - obtained from Property Tax Notice (http: / /app raiser. asco ov.com <br /> p 9 ) <br /> • <br />