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s�3-�eo-oo20 '� City ofZephyfiillsFire� Fax-s�sasaoo2� -_-- <br /> ��✓�/� Permit Appilcation <br /> f-�_ <br /> Date Recefved °- Phorie Co�tor Pertrdt <br /> o�,ers r�� <br /> � � Owners Phone Ntunbe� �� � �(7 [� <br /> o�,ers,aaa� �833 � � �— <br /> Fee Simple Titleholder Name Titleholder Phone Nurtiber � � � <br /> Fee Simple Titleholder Add�ss <br /> Job Address L°t# C� <br /> Sub Division Parcel# <br /> a <br /> 0 B�o-rr�ram w�s�-aNriu,e►� Q Fumigatlon Terrt <br /> a Comm Ex��t IG�en HoodlDuct � Fiazardous Material('Tier II or RQ Faal'ity}ANNUAL <br /> QCorrtrolled Bum � Hood Installalbn <br /> � ���y���<30 kw � LP/Nahxal Gas-Instaitation <br /> � Emergsncy Ger�erator>30 kw Q LP/Nahual Gas-ANMUAL Sale <br /> � Fra Prote�tion Mairrtenance-ANNUAL � Places of Assernbly-,FINNUAL ______. <br /> � �� .._.�,,,.�. <br /> Sprinkler � ❑ ❑ Ll a Recxeational Bum �'��•l � <br /> Fire Alarm � O ❑ � �� � Sparklers f'�/ .` , <br /> Hood GeaNng � ❑ ❑ � a Sprinkler System installations ' ��J �f� i <br /> �5�, o 0 0 0 0 ����S�S�� ;- <br /> J � v <br /> � Fre Alartn I�ilation � Tonch RaofinglTar Kettle <br /> Rre Pumps � Waste Tire Sto�age ANNUAL ___.--✓' <br /> Fte Works <br /> Ftarmmat�e nppucaaon-nNNUa� � Valuation of Project <br /> Fuei Ta�ks <br /> r. • <br /> Contractor � � ��Y <br /> signature tiegistered Y/N Fee cument Y/N <br /> q�� License# <br /> ELECTRICIA �P�Y <br /> s;gnature Reyis6erea Y/N Fee curte�t Y/N <br /> ,qddress License# <br /> PLUMBER ���Y <br /> signahxe Reslstered Y/N Fee currenc Y/N <br /> qddress License# <br /> MECHANICAI C�Pa�Y <br /> s�g„� Registerea Y/N Fee current Y/N <br /> Address License# <br /> OTHER Cort�arry <br /> Sig�aiure ►te�istered Y/N Fee Cur►ent Y/N <br /> Address License# <br /> ao ■ <br /> Directions: <br /> Fill aut applic�tion cort�lebaiy. <br /> Owner 8 CoMractor sign bat�Jc oF application.r�rized(Or.copY of signad contract with ov�rt►er) <br /> tf ov�52500.a Notice of Camme�rnent is rsquired.(Machartical work over 55000) <br /> St�piy two(2)seta of drawings wiflt epplicabie doCtanerttation <br /> Albw�0-14 days for review after subrtdltal dete. Par�el#-obtained ftom Properly Tax NoUce(htlpJlappraiser.pascogov.com) <br />