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^ s�s=7so-oo2o City of.Zephyrhilis Fire � �����
<br /> Permit Appiication Fax-8�3780-0021
<br /> Date Received
<br /> :�+ ,,,,,,,,,_. ;„,,,,� ,,�,,,�,,,, Phone Cont�at far Permit �
<br /> Owner's Name F _�
<br /> Ownar's Pncne Nwmber �j
<br /> Owner's Address
<br /> Fee Simple Titleholder Name TRleholder ph�ne Number ���
<br /> Fee SimpleTitleholder Address
<br /> :�'
<br /> Job Addre5s �� 3 Q Qu„ �� � �
<br /> Lot #
<br /> Sub Division Parcei #
<br /> LT!'
<br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigatfcn Tent
<br /> � Comm Exhaust Kitchen Hood/Duct � HazarrJaus Metenal (Tier !1 or RQ fanility) ANNUAL
<br /> � Controlled Bum � Hood fnstafi�tion
<br /> � Emergerscy Gerteratar < 30 kw � LP/FJatural Gas-Instailation
<br /> � Emergency Generator > 3a kw � LP/Naturai Gas-ANh1UAL Safe
<br /> � Fire Pmtectian Maintenance-ANNUAL � Places ofAssembly-ANNUAL
<br /> Q � em� Rn er �
<br /> Sprinkler ❑ ❑ ❑ Recraetianal Bum
<br /> Fire Alartn � p p ❑� � Sparkiers
<br /> �2 � l� I �� � Hood CleaNng � ❑ ❑ C] � Sprinkfer System Ittstallations
<br /> � Hood Su r^ �'1
<br /> �pression � �' ❑ ❑ St2nd i es S '
<br /> � �__I � p p ( pnnkler Sys)
<br /> Fire Alartn instailafion � Tor�h Roafingrl'ar Kettle
<br /> � Fire Aumps � Wasta Tire Storage ANNllAL
<br /> a Fire Warics
<br /> � Flammat+ie Application- Ah1NUAL """
<br /> � Valuation of Project
<br /> Fuei Tanacs
<br /> Q Oth2r.
<br /> �!r,;x�
<br /> Contractor
<br /> Comparry '
<br /> 5ignature � Registered Y/ hl Fee Currertt Y/ N
<br /> Address � License #
<br /> ELECTRICIAN s.c� Campany '—"
<br /> Signature Ragistered Y/ N Fae Gurrsnt Y/ IW
<br /> Address
<br /> License #
<br /> PLUMBER
<br /> Company
<br /> Signature Registered Y/ N Fea Gurrent Y/ N
<br /> Addrass Li�ense # ��—��—"—"""'�'�
<br /> lvfECHANfCAL
<br /> Company
<br /> Signature Registered Y/ h! Fee Current Y/ N
<br /> Address
<br /> �scense �
<br /> OTHER
<br /> i Company —
<br /> Signature Registerad Y/ N Fee Gu:Tent Y I�
<br /> Address
<br /> � ,�,,,,,�,,,,.�,W o�,.���+�u..�+�,v��,�w..+, License #
<br /> Directions:
<br /> FIl ou, appiicatio� completely �
<br /> Owner & Contractor sign back af application, notarized (Or, copy of signed contract wiYh owner)
<br /> If over $2500, a Notice of Commertcement Is raGuired (Mechanical work �ver $5000)
<br /> Suppiy twc (2) sats of drawings ��,�ith applicable documentatlon
<br /> Allow 1 D-14 days for review a�ter submittal date. Parcei #- obtained frflm Properry Tax Nottce (http;//appra�ser.pascogov.com)
<br /> ��'y�l ��-�— � � ��� I' CY�- �, � c� � �- S� � �c�,c � "�%�-� e .
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