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� s���ao-oo20 ,/� CityofZephyrhiUs Fax-al�-�so-oo2�
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<br /> / ��� Permit Application
<br /> Date Received .� Phone Contact for Permit ( 1�'
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<br /> Owner's Name ANDERSpN pRE Owners Phone Number � Rl � � �� �
<br /> Owner`s Address 510�+ MIJRRAY
<br /> Fee Simple Titleholder Name Tttfeholder Phorre IJumber �� ��
<br /> Fee Simple Trtleholder Address
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<br /> JobAddress GOLDEN CORR.AL GALI� BLVD ZEPHYRHIL • — �ot# wr `�
<br /> Sub Division Parcel #
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<br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent
<br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> � ConUolled Bum � Hood lnstallation
<br /> � Emergency Generator < 30 kw � LP/Natural Gas-Installation
<br /> � Emergency Generetor > 30 kw � LP/Naturel Gas-ANNUAL Sale
<br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL
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<br /> Sprinkler � ❑ ❑ ❑ Q Recreational Bum � Q�
<br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers % /� � 'L �
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<br /> Hood Cleaning �� ❑ ❑� � Sprinkler System In lations
<br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sy �_ _
<br /> � Fire Aiartn Installation � Torch RoofinglTar Kettle
<br /> Fire Pumps � Waste Tire 5torage ANNUAL
<br /> Fire Works
<br /> Flammable Application- ANNUAL � Valuation of Project
<br /> Fuel Tanks
<br /> Q Other:
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<br /> Contractor Company
<br /> Signature Registered Y/ N Fee Current Y/ N
<br /> Address License #
<br /> ELECTRICIAN Company
<br /> S�g�w� Registered Y/ N Fee Current Y/ N
<br /> ' Rddress License #
<br /> PLUMBER � Company
<br /> Signature Registered Y/ N Fee Current 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 CuRent Y/ N
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<br /> Address License #
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<br /> Directions:
<br /> FII out application completely. �
<br /> Owner 8 Contractor sign back of appliqtion, notarized (Or, copy of signed co�tract with owner)
<br /> tf over $2500, a Notice of Comr�encemerrt is required (Mecharrical worlc over $5000)
<br /> Supply two (2) sets of drawings w�h applicable dxumentation
<br /> Allow 10-14 days for review after submittal date. Par�el #- obtained ftvm PropeRy Tax Notice (httpJ/appraiser.pascogov.com)
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