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'���•-�so-oczo Ci'ry ofZephyrhilis Firs Fax-8',3-780-OC21
<br /> � l�� Permit Appiication
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<br /> Date Received � .i
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<br /> Phone Contact for Pertnit �o��j
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<br /> Owner's Name �}LL Up ��� Owner's Phon>Number �_� C� �
<br /> Owner's Address �6 JC' (�L L ���� �� r'L �
<br /> Fee Simple Titleholder Name Titleholder Phone Number � C� �
<br /> Fee Simple Titienolder Address
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<br /> Job Address � l?�� v Lot t �
<br /> Sub Division Parcel# � _
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<br /> � Bio-Hazard Waste Storege-ANNUAL � Fumiaation Tent � K
<br /> � Comm Exhaust Kiichen Hood/Duct � Hazardous Material(Tier II or R(1 Facility)ANNUAL
<br /> � Controlled Bum � Hood Installation
<br /> � �mergency Generator<30 kw � LP/Natural Gas-Installafion j `
<br /> � Emergency G=neretor>30 kw � LP/Naturai Gas-ANNUAL S e r
<br /> � � � j�� 1
<br /> Fire Protection Maintenance-ANNUAL Places of Assembly-AN AL �
<br /> � ny emi � her � �
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<br /> Sprinkler L� ❑ Recreauonal Bum r
<br /> Fire Alarm � p ❑ 'L� � � Sparklers
<br /> Hood Clearnng � i, ❑ O � Sprinkler System Install 'ons
<br /> Hood Suppression � ❑ ❑ ❑ � � 5tandpipes(Sprinkler Sys) '^-- ._
<br /> � Fire Alartn Installation � Torch Roofing/Tar Kettle
<br /> n Fire Pumps � Waste Tire Storege ANNUAL
<br /> � Fire Works
<br /> � Flammable Application-ANNUAL V�luation of Project
<br /> Fuei Tanks
<br /> � Other:
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<br /> Contrector "
<br /> Company
<br /> Signature Registered Y/N Fe=_Current Y/N
<br /> Address License#
<br /> ELECTRICIAN Company
<br /> Signature Registered Y/N Fea Current Y/N
<br /> Address
<br /> License#
<br /> PLUNIBER �
<br /> Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address
<br /> Licensz# -�
<br /> McCHANICAL Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Addr=ss License� -�
<br /> OTHER � • Company QL�.� (--si�� pRO r�C r��A> �_x��_
<br /> Signature � Registered N Fee Current Y/N
<br /> Address
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<br /> License# ( �Qi�� � � ��
<br /> Directions: .._ , ..,_.�._�._<,.w._._:.�.....,._w,_�....�_,w_. .-- -.. ... . .. . ... ....._.x....,.x.....�,..,...,.<<,__,..- '--_.._.,. _.�._... �:-.... _.
<br /> Fill out application completely
<br /> Owner&Contractor sigr,back o�application,notarized(Or,copy of signed contract with owner)
<br /> if over�250G 2 Notice of Commencement is required(Mechanical work over W5000)
<br /> Supply two f2)sets of drawings with applicable documentation
<br /> Allow 1 G-14 days for rewew after submittal date Parcel�-obtained from Property Tax Notice(http.//appra�ser.pzscogov.com)
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