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81 ���� City af Zephyrhilis Fire Fax�1378Q0021 <br /> Permit Application <br /> oate R��a PFwne Cor�tact for Permit `�o�- y7 / C�S'" - O <br /> Owner's Name �� `,t lt/ � j N Owner's Phone Number ���� <br /> J <br /> oW�rs aad�� �O �� 5 LL S L- 3.3 �� 2 <br /> Fee Simple TiNehokier 1Vame T�ffieho4des Phone �mbes C� �� �� <br /> Fee Simple T�leholder Address — J <br /> JobAddress 3JU �c(�)� �ji ` r y� S (� �7�2 Lot# � <br /> Sub Division �� � <br /> a B ��� �� ��� - A � U � a (Tier II or RQ FacA' ANNUAL <br /> Hazardous �Aaterial �Y) <br /> � Comm Exhaust Kichen FfoodlL�uet � 1�iood 1ns1a1tation <br /> � CO � O �� �� � LPMaturaf Gas-Installation <br /> � Emergency Generator < 3p �y � LP/Natural Gas-ANNUAL Sale <br /> � Emergency Genetator > 30 kw Places of Assemby-ANNUAL �"��� � <br /> Fire Protection Mair�tenance - ANNU/U. � Recreatiorral Bum (i(j� ���7�{ <br /> ❑� � �� ❑ � <br /> Sprinkler ❑ ❑ ❑ Spar}ders � � <br /> Fire Alarm � ❑ ❑ ❑ � � SprinMer System Installations � 'b � G � � • �►'� . <br /> Hood Cleaning � ❑ p p �� ❑ <br /> Standppes (Sprinkler Sys) <br /> M�sd Suppressiori � ❑ � ❑ � � Torch Ro�ng/Tar Kettle / C � � <br /> � Fire Alartn Inslatlation � Waste Tire Storage ANNUAL ��� �[ J <br /> Fire Pumps � <br /> Fire Works <br /> Flamrr�ble Application- ANNUAL r <br /> 1 Valuation of Project <br /> Fuel Tanks <br /> � Other <br /> Corriractor <br /> Signature _ �.v�'�l� ''��" ��� ro � � i✓L <br /> Registered f N Fee CuReM /(� <br /> Adchess 31bi �,T i� C�Y�S J r (. / �icense � � 2p(� <br /> ELECTRICiA <br /> Company <br /> Signature Regis6ered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> PLlANBER <br /> Si�ature <br /> �P�nY <br /> Ra9�red Y/ N Fee curre�t Y/ N <br /> Address <br /> License � <br /> MECHAf�CAL <br /> �cem <br /> Signature Regisbered Y J N Fee Curre�t Y! N <br /> Address <br /> L.icense � <br /> OTHER <br /> �RY <br /> Signahrre R�g'rsSered Y/ N Fee Currertt Y/ N <br /> Address <br /> License �C <br /> Directions: <br /> Fill out application completey. <br /> Owner & Cor�r-actor sign �ck of appfication, ndar¢ed (or, copy of signed co�rad wi7� owner) <br /> If over $25Q0� a Notice ofi Comrtiencert�ent is required (Mecherucal work over j5U00) <br /> Supply two (2) sets of drawings w�th appicable do�ume��n <br /> Albw 10-t4 days for review after submittal date. Parce1 #_ obfained from Property Tax Notice (MtpJ/a <br /> PP►a iser. pa scogov. com) <br />