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e�sasaoozo City o#Zephyfiills Fire Fax-813-�80-0021 <br /> Permit Appfication <br /> ate Received ���-f�� Ph�ne Contect for Pertnit �] c7 °J �070 <br /> vmer's Name F Ofi Ownefs Phone Number ��3 7Z3� $yyQ <br /> wner'sAddrass 3p�3 ✓Vl Ke� Ge � ��� �? <br /> ae Simple Tilleholder Name Titlehoider Phone Number � � C� <br /> se Simple Titlehaider Address <br /> �bAddress Jo��� C.� 7 � ,-/ L �7� Lot# � <br /> �b Division G- � �' Paroei# - - � - -� <br /> aBio-Hezard Waste Storege-ANNUAL Q FumigaUon Tent <br /> � Comm Exhaust tGtchen Hood/Duct � Hazardous Materiel(Tierlf or RQ Fscility;ANNUAL <br /> � Controlled Bum o Hood Instaliation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Instailation <br /> Q Emergency Generator>30 kw � LPlNatural Gas,ANNUAL Sate <br /> Q Fire Protection Maintenance-ANHUAL � Piaces of Assembly-ANNUAI <br /> �y em � er ��� <br /> Sprinkier � D � O � � Recreational Bum j?j <br /> Fire Alartn � ❑ D ❑ � � Sparklets � <br /> Hood Cleaning � 0 � O � � Spdnkler 5ystem installations <br /> Nood Suppression � ❑ ❑ ❑ � a Standpipes(Sprinkler Sys} <br /> ,� Fire Alartn Instalfetion Q Toroh RooflnglTar Kett1a <br /> a Fire Pumps � Waste Tire Storege ANNUAL <br /> Fire Works <br /> Flammable Application-ANNUAL Valuation of Project <br /> i <br /> Fuel Tanks <br /> Q Other. <br /> �ntractor —1 <br /> CompanY � .,�....�rC La,..,�.nvu�a-/.-�.,,< ��. <br /> gnature Registered ( Y C N � Fee Current Y/N <br /> Address �J � �, Ucense# / <br /> .ECTRICIAN Company �— `� <br /> gnature Registered Y/N Fee Current Y/N <br /> Address License# <br /> _UNiBER Company � <br /> �nature Registered Y/N Fee Current Y/N <br /> Address License# <br /> �CHANICA Company �", <br /> �nature Registered Y/N Fee Current Y/N <br /> Address <br /> Ucense# <br /> CHER j --- <br /> � - Comparry � <br /> 3nature -^� Registered Y/N Fee Current Y!N � <br /> Address � —� <br /> license# <br /> �ections: <br /> Ftll out appllcatlon completely. <br /> Owner&Contractor sign back oi applicetion,notarized(Or,copy of slgned contract with owner) <br /> If over$2500,a Notice of Commencement is required(Mechanical work over$500D) <br /> Suppty two(2)sets of drawings with appliceble documentation <br /> Altow 10-14 days for reviaw after su4mittal daie. Parcel#-obtained from Property Tax Notice(http://appraiser.pa5cogov.com} <br />