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313- 0020 City of ZephyrhUls Fire' rdx -o 1, - ' 0, I .
<br /> Permit Application I' ( 7 __ . -
<br /> Date Received Phone Contact for Permit IN 3 GLi 1 34
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<br /> Owner's Name " ,. Ntit i (24_ "tT+t` (...C,G Owner's Phone Number
<br /> Owner's Address 1Z4 C'�cx>. -S*0 I+r7z z.. - f c • f t.A- GrnlA)V PI- 1 1 4Lb 1--
<br /> Fee Simple Titleholder Name , Titleholder Phone Number
<br /> Fee Simple Titleholder Address
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<br /> Job Address /3q 4 z - &' /i • Zia - )hf.L.- , • Lot#
<br /> Sub Division G/ i' 0(' Z I y f, 2 Parcel # ' S' ZI • OOt 0 • oncer a o o O
<br /> n Bio -Hazard Waste Storage - ANNUAL f 1 Fumigation Tent
<br /> 1 1 Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier 11 or RQ Facility) ANNUAL
<br /> n Controlled Burn 1 ( Hood Installation
<br /> 1 1 Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> 1 I Emergency Generator > 30 kw 1 1 LP /Natural Gas - ANNUAL Sale
<br /> 1 / Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL
<br /> IUtriy) 'semi' (W Other
<br /> Sprinkler r/ tfJ ❑ ❑ 1 1 Recreational Bum
<br /> Fire Alarm 1 I ❑ ❑ ❑ I I 1 Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ 1 I I Sprinkler System Installations
<br /> Hood Suppression 1 1 ❑ ❑ ❑ I 1 1 Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation 1 1 Torch Roofing/Tar Kettle
<br /> M Fire Pumps Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> Flammable Application- ANNUAL I C r4s -JO I Valuation of Project
<br /> Fuel Tanks
<br /> Q Other: 1 I
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<br /> Contractor . C721 2 -1' - Till ir � Company RODPrN F;(& man g t nc • I
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<br /> Signature �— � 1 Registered Y / N I Fee Current Y / N r I
<br /> Address 1 , I License# *I,g4,s Toed)Ig94 I
<br /> ELECTRICIAN Company
<br /> Signature Registered Y / N ` Fee Current 1 Y/ N J
<br /> •
<br /> Address 1 1 License # ( 1
<br /> PLUMBER Company
<br /> Signature Registered Y/ N 1 Fee Current 1 Y / N 1
<br /> Address 1 License #
<br /> MECHANICAL Company
<br /> Signature Registered Y / N i Fee Current 1 Y / N 1
<br /> Address 1 1 License # 1 1
<br /> OTHER Company
<br /> Signature • Registered Y / N 1 Fee Current 1 Y/ N
<br /> Address License #
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<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)
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