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813 - 780 -0020 City of.Zephyrhllls Fire rd7.-O .)-10V-VUL <br /> • <br /> Permit Application - . - <br /> Date Received d`��' P hone Contact for Permit <br /> Owner's Name "x'(514) NI Ni I t? ) Ro I N-1 c (...L.c. Owners Phone Number 1 1 1 1 <br /> Owners Address 1 Ls e. O 11-41-4--0 )-1 ex ILC7% < R-D . +-A- C. WNt.J'4D , PA • 1900'1 10 z <br /> Fee Simple Titleholder Name Titleholder Phone Number , <br /> Fee Simple Titleholder Address <br /> Job Address 'j St) 6 C91ktL 13 G.v D • Lot # <br /> Sub Division Gi M l.* ZLRf' -$1U -S Parcel # 3$ • ZJ • L) • 0u I 0 - 0 Boo Doob <br /> El Bio -Hazard Waste Storage - ANNUAL El Fumigation Tent <br /> El Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I — I Controlled Bum n Hood Installation <br /> Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> El Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale (Z,....2. <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly NUAL ( 0 f <br /> Sem j iI Uther <br /> Sprinkler E " ❑ ❑ I Recreational Bum 0 <br /> Fire Alarm El ❑ ❑ ❑ l I n Sparklers <br /> Hood Cleaning 0 ❑ ❑ ❑ . I I I Sprinkler System Installations ..,„/"-------- <br /> Hood Suppression ❑ ❑ ❑ I I Ej Standpipes (Sprinkler Sys) <br /> CD Fire Alarm Installation = Torch Roofing/Tar Kettle <br /> Fire Pumps pi Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application - ANNUAL 1 A • vo I Valuation of Project <br /> Fuel Tanks <br /> Q Other: [ <br /> Contractor '12..t4 T- f� 2 Company iZODP+.t C1V- SP�nti -W74S /NC- • <br /> Signature Registered (p/ N I Fee Current I Y/ Ni i <br /> Address I fr.l • lot "` 1/41V r pc. 3 I . License # LI G8 0 jy oo ) t 9S 9 I <br /> ELECTRICIAN Company <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current L Y/ N I <br /> Address I I License # I <br /> OTHER Company <br /> Signature Registered Y/ N 1 Fee Current I Y / N <br /> Address I License # <br /> wr�rmrww+, a���rorurr�cre.s - _ <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 $2500, a Notice of Commencement Is required (Mechanical work over $5000) <br /> Supply two (2) sets of drawings with applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http! /appraiser.pascogov.com) <br />