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e�saaaoo2o City of Zephyrhilis Fire �` Zb [� Fax-813-780-0021 <br /> . <br /> . Permit Application <br /> Date Received ���� „ . Phone Co�tact for Pertnit `,� �,, . <br /> Owners Name ��� � 5 Ow�er's Phone Number �� �� <br /> Owner'sAddress 7 � 9 C94, // l��v <br /> Fee Simple TiUeholder Name Titlehotder Pho�e Number r�� �� <br /> Fee Simple 7itiehotder Address <br /> .. r.,. ��:,.:: _ s.��., , a=:=�,.;+, z _ _ ; r�:;,�:-,-;=:x'�. . -_- ,� , _, ,. . �•�r-.; - <br /> Job Add2ss / Qd �! � 1� ` G Lot # � <br /> Sub Division Parcel # <br /> ., , . � , r � ._ ., .�. ._ - -° � -,:�:�.� �..,,....�_, ,._�. <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> � Controlled Bum � Hood Installation <br /> a Emergency Generator < 30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator > 30 kw Q LP/Natural Gas-ANNUAL Sale <br /> a Fire ProteCtion Maintenance - ANNIfAL a Places of Assembly-ANNUAL <br /> �y emi �n er <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning �❑ ❑ ❑ � w�'C � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � Standpipes (5prinkler Sys) <br /> � Fire Alarm Installation � Torch RoofinglTar Kettle <br /> Fire Pumps � Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNlIAL Valuation of Project <br /> Fuei Tanks <br /> Q Other� <br /> _ . . . ... � .. :.�x. -. . _ ,. _ . , . .. . . �;M .-. , �, . .. - . � T _.. - <br /> Contractor / Company -a.� ,�.t <br /> Signature Registered c�/ N Fee Curcent �ffi/ N <br /> Address ) /ha l � �' 3 �/ �icense # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N Fee Current Y 1 N <br /> Address License # <br /> PLUMBER Company <br /> Signature Registered Y 1 N Fee Cument Y I N <br /> Address LiCense # <br /> MECHANICAL Company <br /> 5ignature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> OTHER Company <br /> Signeture Registered Y/ N Fee CurreM Y/ N <br /> Address License # <br /> Directions: . . _ , _ _ . <br /> Fill out appiication completeiy. <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) <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) <br />