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saso-oo2o City of Zephyrhilis-Fir�• Fax-a�3aso-oo2i <br /> . <br /> Permit Appiicafion _ <br /> Date Received ' Phone Co�tact for Partnit �� <br /> . _ _��.'�t•::.;_��w.�...>, ._. .,�......._...,t_ ~�.��^z��:5���< ,�.. sro�r�w'-'�..„.�,.---���� <br /> Owner's Name ANDERSOlV pRE Owners Phone Number .Rl '� � RRL� � ��pg <br /> Owners Address 5].OL� j�j�Jj�R�jy <br /> Fee Simpie Titleholder Name Titleholder Phone Numher � � � <br /> Fee Simple Titleholder Address <br /> ��,.�-�.�-A�.�:,���°�, ..;�•-�z,,,� . � :•�� ..���:.a�.�.,�:�. ->�-- � <br /> :.�,:::��?x, .. . � . .., ab��s�€77 _. _�'� .r.. z. N�,`'�. �"` .�... _ �=...:o.:..xs:.:��`^;.!�:;"' <br /> Job Address�� rv GOLDEI�T CORRAT� G8S S GALL BLVD. Z���n,� n — Lot# � <br /> Sub Division Parcel# <br /> �. . ,_r._....�-.,�.�,.._:.. :�-:�-..?-:..�� ;��°�r�� �.:���..-��� ,•�.�.���:.:�;���:':��.:-�:�y-:�:�.::..��;v:�:�;,:,�:� <br /> �r BiaHazarci Waste Storege-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hoad/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Instailatian <br /> � Emergency Generator>30 kw � LPMatural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNU °p <br /> �y emi �n r <br /> Sprinkler � ❑ ❑ ❑ � Recreatio�al Bum j f�� � <br /> Fire Alarm � ❑ O ❑ � � Sparklers � ( � � <br /> Hood Cleaning �� ❑ ❑ � � Sprinkler System tns lations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sy ���� <br /> � Fire Alartn Installation � Torch Roofingffar Kettle <br /> Fire Pumps � Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application-ANNUAL Valuation of Project <br /> Fuel Tanks <br /> Q Other: ' <br /> ._��• W�. r��. <br /> Contractor Company <br /> Signature Registered /N ee CuRent Y <br /> Address License# <br /> ELECTRICtAN Company <br /> Sigrtature Registered Y/N Fee Cument Y/N <br /> Address License# <br /> PLUMBER Company <br /> Signatu2 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 Current Y/N <br /> Address License# <br /> x ��„a,.>� Y.� �- �- <br /> Directions: <br /> Fill out applica6on completely. <br /> Owner 8 Contractor sign back of application,notarized(Or,copy of signed contract with ovmer) <br /> ff over$2500,a Notice of Commencement is required(Mechanical work over$5000) <br /> Supply two(2)sets of drawirigs with applicable documerrtation <br /> Allow 10-14 days for review after submittal date. Par�el#-obtained from Property Tax Notice(httpJ/appraiser.pascogov.com) <br />