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• , - . _ . _ _ _ ., ,...,. _ _
<br /> .,..---. ..:.. __:..... ...., ._:.,:',-,, ...-.....:i. LEPERHILLS BUILDING
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<br /> 81t.;.i.730-0020 City of Zephyrhilis'izim.. . F2x71:113-780-0(P1
<br /> - Permit Application
<br /> r ______
<br /> 7 — -----] Phone Contact for Permit 1 -,,I,=7-1
<br /> D,•1:182!Itittcikaic.a. .tt.tNati . ---NOVIHrZatiladValtaaignanglairMISLOBWIECW4INAMCL90601&54004rjggersatg-.....r...,,,,,,,......., — - ....4 . .....1.00.1,,, - ./... ,
<br /> ne7 N ame - - , 0.; , Owner's Phon e Number
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<br /> 0vrvez AddrasE: L ,D 1 „, t 111 . G- - \ c,,, . - - . • ...
<br /> 1 1 Titleholder PhOna Number _I
<br /> F-' Sin e oDl fit1.3hddE,;:r 1l 1 -----..—
<br /> i — —
<br /> ..--_----
<br /> Fac Simple Titleholder Address —
<br /> l . • • — • ostivirttimeritiorostkiromerstoi _Ara
<br /> :t.2;tilltillFiTit114.nttiiiptlitinE=1.1.;,=1.1$00,:ggigeliieliNIOVIte" killith*Weat$0131028110225501$111$61510FiNOMM$116' RerAMittglItientniar.. . . ili$4167.01$4=f
<br /> Job Lot # Address • I 6-9_3.1 r\ • Cr-o._ P
<br /> II - • . ... . 1
<br /> t -- - - ---- ------- , ---' ---=---
<br /> Sub Divn 1 --___ Parcel # ______________________
<br /> 7 - 1 Bio.Hea Waste -Storage - ANNUAL El Fumigation Tant
<br /> -----, ,
<br /> ' • :'-rArr Evhduat Kitchen Hood/Duct , • 1 ..._ 1 Hazeizious Material (Tier 11 or Ftla Facility) ANNUAL .
<br /> •
<br /> 1 ____i C::ritro'I0 Burn fl Hood Installation
<br /> •-----. E3
<br /> ergcy Genrator 30
<br /> LP/Nat ural Ges-Instellation --•'--.
<br /> Emene :.t kw
<br /> -1-.11"%b 9 CCAA 0 n 1 - - -1- L 1 LP/Natural Gas-ANNUAL
<br /> ,
<br /> i j Emergency Oenerator ..-, 30 kw
<br /> l 3 0 n X P: re t Malnittriancs - ANNUAL . - fl Places of Assembly-ANN
<br /> - DE Fzi
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<br /> R ? r x \ n' , ; Sprinkler 1 -___- . :1 0 0 CO
<br /> . 1 Reoreetional Burn -
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<br /> • ...C) 0 1 ,Fire Alarm Li p m 1 : J Sparklers
<br /> 1. Cleaning L: l:1 o o r 1 • - - - n Sprinkler System installations
<br /> 60 g g ' f+i-YYN ,, ./rAtik.rtupprest:ilor• L.....i 0 X 0 = Stendpmes (Sprinkler Sys)
<br /> . —
<br /> Fire Alarm instelletlon , '7 7 Torch Roofing/Ter Kettle
<br /> [:7 Fire Pump s El Waste Tire Storage ANNUAL ,. •
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<br /> F,re WrIrkt':
<br /> Flararnabie Appiication- ANNUAL
<br /> . , ___1 ValUilt1012 of Project
<br /> ; , 1 Fuel Tsnks ________
<br /> OttleR 1------------------- --..----
<br /> tietiel W Z ,ItriesitilWrisatelitlraigNieratoatairOmOnAniegglIMMVIIPMMITTO MICAMINiaatliiiglititeeiettlialeggeitireaRat$592#32015masgaef....44017MelliMissliniemtliteekertAitrre"
<br /> Contractor , Company .
<br /> . tr.
<br /> Signature -
<br /> Registered Y / N j Fee Current Y / N
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<br /> Mdrant,,L License # E-- 1
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<br /> — -- — —
<br /> EL P..CTRICANI . Comp — any •
<br /> Signature . . • Registered --- / 1 1-7775U1717 1 Y / N
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<br /> AddreSt.1: ' . . License t ---------1
<br /> — -- r----
<br /> PLUma ER i Company
<br /> Signature 1 __ Registered Y !N Fee Current 1 Y / N
<br /> — —
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<br /> Adord;,7 1; . i , .... _____:::J License # L_L______—_...
<br /> . '', - .- -: = : -,:._ — .7. . .- - ,..— — —
<br /> mEcHANIcAi , 1 Company'
<br /> Signature , Ftegistered . Y / N J . Fee curre" 77 N
<br /> Atidnads • i____ -- _____
<br /> .
<br /> OTHER
<br /> Company
<br /> in 1
<br /> Sgature I Registered 7 /1 Fee Current 1 Y / N
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<br /> Add reSS . License # . •
<br /> mii out application ogriplfintely.
<br /> QIN' icr & Contraotoi' sign back ot application, notarized (Or, copy of signed contract with owner)
<br /> . ii over $2Fir.10, s
<br /> Net pi commencement is required (Mechanical wcrk over $5004)
<br /> 5upply two (2) r.ettB drawings With applicable documentetion . . •
<br /> Allow 10-14 day!: for after submittal date. Parcel #- obtained from Property Tax Notice (http://appraiser.pascagov.
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