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a�s-�aaoo2o City of Zephyrhilis Fire Fax <br /> Permit Application <br /> Date R�ceived � b � �� Phone Contad for Pertnit p( 3 q 3a � f � O <br /> Ownefs Name W� .S 11S (� Ownei's Phone Number 8� 3 7 � � a�' °J <br /> Owner's Address �� ( S J' ZG h r� � � Ii �L. 3 35 � Z <br /> Fee Simple Titleholder Name Titleholder Phone Number C� C� �� <br /> Fee Simple Titleholder Address <br /> Job Address w��� S �� � g 1 S � S� � t 2 h 1( � �- Lot # � <br /> 5ub Division Parcel # <br /> Q Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator < 30 kw � LPMatural Gas-Installation <br /> Q Emergeney Generator > 30 kw a LPMatural Gas-ANNUAL Sale <br /> � Fire ProtecUon Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> � �� � I 1 <br /> �(����%� Sprinkler � ❑ ❑ ❑ � Recxeational Bum j � � <br /> �� Fire Alartn � ❑ � ❑ � � Sparklers � I <br /> � ��1 (� Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <br /> � <br /> 0 �.i7p� Hood Suppression � ❑ � ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> Fire Pumps a Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> ConVactor W a` ra� J�� �` ;/,� Company <br /> Signature �� �"� Registered Y/ N Fee Current Y/ N <br /> Address (� L (.QN � � t� License # <br /> ELECTRICIAN /IC � s' C � � Company <br /> Signature � y Registered Y! N Fee Current Y/ N <br /> Address License # <br /> PLUMBER Company <br /> Signature Registered Y/ N Fee Currerrt Y/ N <br /> Address License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> OTHER Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> Directions: <br /> Fill out applicabon wmpletely <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contrad with owner) <br /> If over $2500, a Notice of Commencement is required (Mechanipl work over $5000) <br /> Supply two (2) sets of drawirgs with applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http:l/appraiser. pascogov.com) <br /> vIGIL INC <br /> H�od 1!c F.�t CM� Svc. <br /> �11a� I i�� �d�'ess � r.o. s.� s� ��., r� � <br /> p: si�rt-s� F : s�:F�-�a <br /> ga�tor�wa�r@ael.cem <br />