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813 - 780 -0020 Clty of Zephyr hulls Eire' / ran -o io-� ov -wc I <br /> Permit Application W / O a) -' - <br /> Phone Contact for Permit 81 3 (.L f I Szl <br /> Date Received <br /> £:ffa.'J`a•,1.+. "�a.. .. Etia] f1+..'- tA¢tuo- :a`+is•y33ae " " "" .t'��%` "wC'.'A,6•b.'�+.: e. -: <br /> Owner's Name (TbA.fl JK3 ,2 'f1-._ LL.C- Owner's Phone Number I l <br /> Owner's Address 1Z CjASIfo { I7L1CU)' 'Sfl'r4tr R.a 64 CNNt4Yn PA- MO b + 12 -1V <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> t 4....... Y k Z. 4T-' -,''''. =',"4"'WITMOVIMMEMSSEM":4300=2:Mt■fatWaVFM2 - ' , ,,Mtlearga,retenaZiZMESMODAMMWSe taafaS.M5SAZWM <br /> Job Address 7btl$ 6.tist - fbc.ui ZLPM'(/ZI'ill l-s , pl. • Lot* i <br /> Sub Division /' f 1M Oft Z1''A'tY/ -Pti us Parcel # 3d- 2 • Zi - Dv) o • o 8 Ja • Ov oO <br /> i,ti.•4'a"4.: �u2..:i.Y.. t,R 'A 's!: i/(, tYF�tE.aa..t - tea.?- ec.*+1- hK�rTS"a 3Y- 45 -aa.-- ., M,IG".J'f&1r...n ,n .fl- ate.. ;:b.i:.`.. ,.. -T l�'"_:rFY ... <br /> n Bio- Hazard Waste Storage - ANNUAL n ri Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RO Facility) ANNUAL <br /> I I Controlled Burn I Hood Installation <br /> ED Emergency Generator < 30 kw I j LP /Natural Gas - Installation <br /> I I Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> { Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL <br /> y� r y 'Semi! Fill Other <br /> Sprinkler / 1 p' ❑ ❑ I I Recreational Burn <br /> Fire Alarm ❑ ❑ ❑ I I I I Sparklers <br /> Hood Cleaning ❑ ❑ ❑ I I I Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ 1 I Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> Fire Pumps 1 1 Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL Iat1 ( Valuation of Project <br /> Fuel Tanks <br /> Q Other: I <br /> Contractor ` cGrK2 -Y `t ir— .!"�-- Company Qo> l 1.1 • I <br /> Signature .r Registered Y / N I Fee Current Y / N <br /> Address I I License* tk, At m 40 cO 1 tSS4 I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address 1 I License # ( I <br /> PLUMBER Company <br /> Signature Registered Y / N I Fee Current I Y/ N 1 <br /> • <br /> Address I 1 License # I <br /> MECHANICAL Company <br /> Signature Registered Y / N I Fee Current I 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 L stml <br /> 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 Is required (Mechanical work over S5000) <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 />