Laserfiche WebLink
- !1 -/0 <br /> 813 - 0020 City of Zephyrhilis'Fits, 1 �� � Fax- a1a -7$o -0021 .1.1 <br /> Permit Application _ - <br /> t?abe Receive Phon Contact Permit x l _3 Mil i <br /> Owner's Name 1 IU'I - - T - ( s _5 / I Owner's Phone Number .1 1 I 1 I 1 <br /> Owners Address 1 7 Gddi Rili4 <br /> Fee Simple Titleholder Name I I Titleholder Phone Number I l <br /> Pee Simple "Titleholder Address I I <br /> Job Address 1 7 ?n 7 G.,// 1S) J t1 Lot 1 1 <br /> Sub Division , I Parcel # 1 I <br /> ED Bio- Hazard Waste Storage -ANNUAL a Fumigation <br /> E Comm ExhaustlQtdren Hood/Duct 0 Hazardous Material (tier it orRQ Faciity) ANNUAL <br /> Contrcded Burn ED Hood Installation <br /> n Emergency Generator < 30 kw El LP/Natural Gas - nation <br /> Q Emergency Generator> 30 kw r LP/Natural Gas- ANNUAL Sale <br /> fJ Are Protection Maintenance - ANNUAL Ji Places of Assembly- ANNUAL <br /> SRI larrin MI 1. <br /> Sprinlder ID ❑ ❑ EMI El Recratational Bum <br /> Fire Alarm ❑ ❑ 0 I ( ED Sparklers <br /> Hood Clearitng 0 0 ❑ 1 /46,...,x1 E Sprinlder System Installations <br /> Hood Suppression El 0 0 0 r I Standpipes (SprkrMer Sys) <br /> I Fire Alarm installation n Torch Roofing/Tar Kettle <br /> rl Fire Pumps Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flerrwnable Appllcaiico-ANNUAL 1 I Valuation of Project <br /> Fuel Tanks <br /> n Other: 1 I <br /> Company i�. -7 ,ir�1u/ - I <br /> Signature 7--- 1 Registered / N i Fee Current 1 Y/ N 1 <br /> Address J I ' Li ce nse# .. 1 I <br /> ELECTRIc1AN Cerny <br /> Signature - Registered Y/ N I Fee Currant I Y/ N I <br /> Address L 1 License # I 1 <br /> PLUMBER 1 Cony 1 <br /> Signature Registered Y / N I Fee Current 1 YIN <br /> Address 1 1 License* I i <br /> MECHANICAL Company <br /> Signature Registered Y/ N J Fee Current 1 Y / N! <br /> Address I 1 • License # J - I <br /> OTHER ( Company I <br /> Signature Registered 1 Y/ N I Fee Current I Y/ N I <br /> Address License # <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 le required .(Mechanical work over $5000) <br /> Supply two (2) sets of drawings with applicable documentation <br /> Allow 10-14 days for review after submlttat date. Parcel #- obtained from Property Tax Notice thtip //appmiser pascogov.corn) <br />