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, a�s-�so-oo2o City of Zephyrhilis Fire Fax <br /> . Permit Application <br /> Date Reoeived � Phone Contact fnr Pertnit �] �� � <br /> Owners Name S �(� f��(� � Owners Phone Number �� � g((� <br /> o�,ers �ad�� l l �^ Q(1 � I�lG� � t�[S � St/Z <br /> Fee Simpte Titleholder Name Titleholder Phone Number �� C� � <br /> Fee Simple Titleholder Address <br /> Job Address �c � , L ( � � 1 U Z � ( ( S ,3�5 Lat # �� <br /> Sub Division Parcel # <br /> a Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitche� Hood/Duct � Hazardous Material (Tier II or RQ Faciliry) ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emerge�cy Generator < 30 kvv � LPMatural Gas-Installation <br /> � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale <br /> �,"� Fre Protedion Mairrtenance - ANNUAL � Places of Assembly-ANNUAL <br /> `�- <br /> C �.. ` �.�G� Sprinkler �� o ef � Recreational Bum C� <br /> � h �uj _�� � 3 <br /> Fire Alartn � ❑ ❑ ❑ C� � Sparklers � � <br /> /__(�� `�� Hood Cleaning ❑ ❑ ❑ �� � Sprinkler System Installations <br /> �`'`�, 0� <br /> � � Hood Suppression � ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> � a Fire Alartn Installation �� OU� ���C � Torch Roofing/Tar KetHe <br /> � J � <br /> Fire Pumps Waste Tire Storage ANNUAL <br /> I I Fire Works <br /> u Flammable <br /> Application- ANNUAL �� <br /> � Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> Contractor <br /> Signature � u � � � Company <br /> r� Registered Y/ N Fee Current Y/ N <br /> �. <br /> ) License # <br /> ELECTRICIAN <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> PLUMBER <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> MECHANICAL <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> OTHER <br /> Signature <br /> Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> Directions: <br /> Fill out application completely <br /> Owner & Contractor sign back of application, notarized (Or, c�py pf signed c�ntract wiqi prme�� <br /> If over $2500, a Notice of Commenoement is required (Mechanipl work over $50pp) <br /> Supply two (2) sets of drawings with applicable documentatipn <br /> Allow 10-74 days fix review after submittal date. Paroel #_ optained {rpm pro�m, Tax Notice h //a raiser. <br /> VIGIL INC � �� � �� <br /> � t j H�od dc E�d� Ck� Svc. <br /> � , N � r.o. ao� r��n � �..�.�. �t �s <br /> P: $13-9t�t �'!N F: �L3-� <br /> g�e�cwa���l•rnm <br />