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� ���-;��-o02o CiryofZephyfiilis'Fir�- Fax-a�3-�ao-oo2� <br /> Permit Application <br /> late Received - Phone Contact far Permit �y�T� <br /> ;�s:���r.:;�z�: ,..a.,,,�, ��� _. �....a..�.�.....� . .� ..._. <br /> hvne�s Name +w�, ° � Q Owner's Phone Number ��,� .,5� 3 J <br /> �,v�er's Address �� h`• S �' � 3� 5 y � <br /> 'ee Simple TiUeholder Name TlNehoider Pfione Number � �� � <br /> =ee Simple TiUeholder Address <br /> �€!�."r1:��?:u`!:��ss��' <br /> �ob Aad�sS . c)c�l.; S «' s � 3 S �at# � <br /> � <br /> Sub Division � � Parcel# –,.�. – � <br /> �.�� - R�:.�y:.._�y;;>���-^��u. <br /> � BiaHazard Waste Stotage-ANNUAL Q FumigaUon Tent <br /> � Comm ExhausY Kitchen HoodlDuct o Hazardous Material(Tier li or RQ Faciliiy)ANNUAL <br /> � Cantrolled Bum � Hood Installatlon <br /> � Emergenoy 6enerator<30 kw � LP/Naturei Gas-Installation <br /> Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> Flre Protection Maintenance-ANNUAL a Places of Assembly-ANNUAL <br /> �y emi � er ��, C� <br /> 5prinkler � ❑ a ❑ � � Recreatlonal Bum `r� <br /> Fre Alarm ❑ ❑ � � � Sparklers � ' <br /> Hood Cleaning � O O ❑ �� a Sprinkler System Installations <br /> Hood Suppression � O ❑ O � � Standpipes(Sprinkler Sys) <br /> aFire Alartn InstaOation � Torcfi Roofing(Tar Kettle <br /> Fire Pumps � Waste Tire Storage ANNUAL <br /> Fire Wodcs • <br /> Flammable Applicaboo-ANNUAL � Valuation of Project <br /> Fuei Tanks <br /> Q Other: <br /> P i�..�'vi4�.-':n���i�£1 <br /> Contractor �,// ' �? Comparry =� ,G � Vr '` C, <br /> Signature ' Registered Y N Fee Current N <br /> Address 1 � License# �b i t`� <br /> ELECTRlCIAN Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> PLUMBER Company <br /> 5ignature Reglstered Y/N Fee Current Y/N <br /> Address Licensa# � <br /> MECHANICAL Company <br /> 5ignature Registered Y!N Fee Current Y/N <br /> Address License# �— <br /> 07HER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address Lioense# �— � <br /> � � +»..�-��� <br /> �liBCbO�S: � .r.,a.,.�« � .�.................�,. _ ......__...,...x�,,.._.r_-�.....c=at�"'�L,l. <br /> Fill aut application completely. <br /> Owner 8 Contraetor sign back of appiicatiot�,notarized(Or,�opy of signed conUact with owner} <br /> If nver$250D,a Natice of Commencement is required(Mechanicai work over�5000) <br /> Supply two(2)sets of drawings with appiicable documentation <br /> Allow 10-14 days for raview after submittal date. Parcel#-abtained from P�operty Tax Notice(http://appraiser.pascogov.00m) <br />