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81?780-OG20 City ofZephyrhilis rire FaX-e,a-�ao-oo2i
<br /> Permit Appiication -
<br /> Di.`.=R=ce'bed act or P t
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<br /> Phone Con e
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<br /> Owner's Name L� - ' ��� t'� ` ' � �♦^�Owner's'Phone Number � � �
<br /> Owner's Address �31n. L � - - �--�>►�`� �-
<br /> ree Simple Titieholder Name ��'�� S�L Titleholder Phone Number � � �
<br /> ree Simple Titlehold=r Address _
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<br /> Job Address �J5 "rl-l-� rJ j L--�P�"f f � H �, Z- Lot€
<br /> Sub Division Parcel� � l • ��p - I —00� � — �00 ` O
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<br /> � Bio-Hazard Waste 5torege-ANNUAL � Fumiaation Tent
<br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ r=acility)ANNUAL
<br /> � Controlled 8um � Hood tnstallation
<br /> � cmergency Generetor<30 kw a LP/Natural Gas-fnstallation
<br /> � Emergency Genere'tor>30 kw � LP/IVatural Gas-ANNUAL Sale
<br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL
<br /> rry emi ni ner
<br /> Sprinkler � ❑ ❑ � � � RecreaUonai Bum � �3S 3-�
<br /> Fire Alarm `� O O �--� � Sparklers
<br /> Hood Cleaning � u � ❑ � � Spnnkier System Ins.allations
<br /> Hood Suppression � G ❑ ❑ � � Standpipes(Sprinkler Sys)
<br /> � Fire Alarm Installation � Torch RoofinglTar Kettle
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> � Fire Works
<br /> � Ftammable Application-ANNUAL �_--� Valuation of Project
<br /> � Fuei Tanks
<br /> � Other•
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<br /> Contractor Company
<br /> Signature Registered Y J N ree Current Y/N
<br /> Address License#
<br /> ELECTRICIAN Company
<br /> Sigraiure Registered Y/N Fee Current Y/N
<br /> Address License�
<br /> PLUMB�R Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address Licensz#
<br /> MECHANICAL Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License�
<br /> OTH�P. . Company — � "�
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<br /> Signature 'L�-- Ragistered I N Fee Current /N
<br /> Address ' cr" D License� .Cj� � -� � '
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<br /> Directions:
<br /> Fill out aoplication completely
<br /> Owner&Contrector sign back o`aoplication,notarized(Or copy of signed contract with owner}
<br /> f�over�2500,a Notice o`Commencement is required(Mechanicai work over W SODO)
<br /> Suoply two(2)s=ts of drawings with appiicable documenta'tion
<br /> Allo��1C-'1�days for review after su6mittai date Parcel�-ob,ained irom Property Tax Notice(nttp:/fapprais=r.p2scoaov.com)
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