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�s;y�so-oo2e City of Zephyrhilis Firs Fax-8�;aao_oc2�
<br /> Permit Application
<br /> Dat=Received � -
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<br /> Phone Contact for Permit �5
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<br /> Owner's Name �� -SL��/ ,� j"5. Owner's Phone Number � C� ��
<br /> Owner's Address 1 5 �C��L��ytKl�� 1���11 STL�•J�� ��(=S ( �F){_Y1'i . ��e1� -- � —�j7v�'c'S
<br /> Fee Simple Titieholder Name Titlehoider Phone Number � ��
<br /> Fee SimpleTitl=holderAddress
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<br /> Job A 'J O`t�� �r� � ._ 40.'�.:�t�'�::s�s::v�.�,„_
<br /> ddress LLL ' ��J�KS ,L �
<br /> J Lot�
<br /> Sub Division
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<br /> � .>_ ._, ��t�.,.,.,... .,., ,�_.,..a> a�, _,�> .� Parcel—� �3 02 .?E •OC�1C��D �?Ca0 p
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<br /> � Bio-Ha_ard Waste Storage-ANNUAL � Fumioation Tent t""y'�"'�"~�-'�N�F�.£"..�
<br /> � Comm Exhaus;Kiichen Hood/Duct , � Hazardous Material(Tier 11 or RQ Facility)ANNUAL
<br /> � Controlled Bum a Hood Installation
<br /> � cmergency Generator<30 kw a LP/Natural Gas-Installation
<br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale
<br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL
<br /> ny emi n� her �
<br /> Sprinkler � � ❑ p � � Recreational Bum � /
<br /> Fire Alarm � 1� �
<br /> ❑ G � � C� � Sparklers /
<br /> Hood Cleaning � r �; ❑ �� � Sprinkler System Installation�•�___ ,
<br /> Hood Suppression � p ❑ ❑ � � Standpipes(Sprinkler Sys)
<br /> � Fire Alarm installation � Torch RoofinglTar Kettle
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> � Fire Works
<br /> � Flammable Application-ANNUAL
<br /> Vafuation of Project
<br /> � Fuel Tanks
<br /> � Other:
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<br /> Contractor ;.�.�.°���1 .�>,:>'w�s::�'��:�::.,�:�z!.�:=.t:'��^��t�;�°.L�:��:..W.
<br /> Sianature Company
<br /> ` R=gistered Y/N Fee Current Y/N
<br /> Address
<br /> License�
<br /> cLECTRICIAN
<br /> Company
<br /> Signaiure Registered Y/N Fee Current Y/N
<br /> Address � �
<br /> License�
<br /> PLUMB�R
<br /> Company
<br /> Signature Registered Y/N Fee Current Y/N (
<br /> Address
<br /> Licensz#
<br /> MECHANICAL
<br /> Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address
<br /> License�
<br /> OTHER
<br /> P Y f Z P�'�2 �r�Is% t2�'T�G TZaJ
<br /> Signature � ' ,`��� Com an
<br /> Registered /N Fee Current Y/N
<br /> Address a 1 L0�1 %
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<br /> �cense�
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<br /> Directions� ,:_•.,._.�_,� � �
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<br /> Fill out application completely "'-" "-'°- `�-�-�•� --� :-�. .._._. .�.
<br /> Owner&Contractor sign back o`aoplication,notarized(Or,copy of signed contract with owner)
<br /> f�over$250Q a Notice o:`Commencemen;is required(Mechanical work over W5000)
<br /> Suopiy two(2)sets of drewings with applicable documentaiion
<br /> Aliow 1 C-1�days for r=view after submittal date Parcei f-obtained from Property Tax Noti-e(http./;app;aiser.pascogo�.com)
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