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813 - 780 -0020 City of Zephyrhlils Fire ra - a t 01.1-1l1.4
<br /> Permit Application . _
<br /> Date Received I Phone Contact for Permit g7 3
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<br /> Owner's Name Fux2t m(.-rttGA -t C,(,,1 rsK. Owner's Phone Number
<br /> Owner's Address 3813 m A►Zx1.1 %MI-4 7(�>i +ed+1 .1...s, pc.. 333a v
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee SimpleliitleholderAddress I I
<br /> Job Address 38 10 1 AA fk(Z _ 1 )AR.$ Lot #
<br /> Sub Division L r( OP jeTht'{JZ141U -3 Parcel # , pL • L(s , Z► • 0/7 1 o . 03S00• ]
<br /> El Bio -Hazard Waste Storage - ANNUAL I Fumigation Tent
<br /> n Comm Exhaust Kitchen Hood /Duct I I Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> n Controlled Bum I I Hood installation
<br /> I I Emergency Generator < 30 kw I ( LP /Natural Gas - Installation -
<br /> I I Emergency Generator> 30 kw I LP /Natural Gas - ANNUAL Sale r ( ( 1 U
<br /> ( I Fire Protection Maintenance - ANNUAL I - I Places of Assembly - ANNUAL � f
<br /> ry !semr1 FiTi I Uther
<br /> Sprinkler I ` I ¢ ❑ ❑ ( Recreational Bum
<br /> Fire Alarm ❑ ❑ ❑ I I I 1 Sparklers
<br /> Hood Cleaning 17 ❑ ❑ ❑ I I I Sprinkler System Installations
<br /> Hood Suppression u ❑ ❑ ❑ I 1 1 Standpipes (Sprinkler Sys)
<br /> FT Fire Alarm Installation Ii Torch Roofing/Tar Kettle
<br /> HI Fire Pumps I I Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> I Flammable Application- ANNUAL 1 IS Js-, 1 Valuation of Project
<br /> n Fuel Tanks
<br /> 0 Other: I
<br /> ;,:,s; x. a^ .x�ra;?c ,.. �.e, ,a +, , -.:,t- �-.c,. ,�eq;y .�.,,:v.rF . Kx,.rvw ,,. ...,.5...- ..,,- ......�-.�+. -�s.x� ,z;..- s..m,._: ...,..cs.. o-k , a,a:.�. t ;::<ta. . »-r. -.r _ - _czsFn.w,. •,
<br /> Contractor 7r7 Company a t r-' JfZ1� 542.)►J.4....a., 1lx• • I
<br /> Signature � Registered CO N I Fee Current I -r/ N 1
<br /> Address row I License # I (U e 4I3 Z.00011 c gS I
<br /> ELECTRICIAN Company
<br /> Signature Registered Y / N I Fee Current I Y / N
<br /> Address I License # I 1
<br /> PLUMBER Company
<br /> Signature Registered s Y / N I Fee Current I Y / N J
<br /> Address I I License # I
<br /> MECHANICAL Company
<br /> Signature Registered Y / N I Fee Current 1 Y/ N I
<br /> Address I I License # I
<br /> OTHER Company
<br /> Signature Registered Y / N I Fee Current I Y/ N J
<br /> •
<br /> Address I License I
<br /> � 3. rriX�"'.$� # ,cF"
<br /> Directions:
<br /> Fill out application completely.
<br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner)
<br /> -
<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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