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a���aso-oc2e City ofZephyrhilis Fire Fax-8'3-780-0021
<br /> Permit Application
<br /> Dace Receiv=d I Phone Co�tact for Permit '7� o�e5 �jc�
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<br /> Owner's Name �C7Y\rt! LUTZON � �. L-� Owner's Phon=Number � � �
<br /> Owner's Address y o� I.J��.►.� F�nr�U �ti�T�J° - �(� 5 7 rH �T
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<br /> Fee Simple Titiehofd=r Name Titleholder Phone Number C� � �
<br /> Fee Simple l'itlenolder Address
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<br /> Job Address I�I)1�� ��L 1 lr� 9"�/UQ }2� Lot r l,�
<br /> SubDivision Parce�r �5'aJ` � � -(�Dl�i•-�'1�]1 —�C�O�
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<br /> Bio-Hazard Was'te Storege-ANNUAL � rumigation Tent
<br /> � Comm Exhaust Ki'tchen Hood/Duct , � Hazardous Material(Tier 11 or RQ r=acility)ANNUAL
<br /> � Controlled Bum � Hood Installation
<br /> � cmergency Generetor<30 kw � LP/Natural Gas-Installafion
<br /> � Emergency G=nere'tor>30 kw � LP/Natural Gas-ANNUAL Sale
<br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL � p/(�j�
<br /> ny emi �n ner � ' G �
<br /> Sprinkier � ❑ ❑ O � � Recreauonal Bum !
<br /> Fire Atarm � ❑ p ❑ � � Sparklers �
<br /> Hood Cieaning � �, C ❑ � � Spnnkler System Installations
<br /> Hood 5uppression � ❑ ❑ �, � � Standpipes(Sprinkler 5ys)
<br /> � Fire Alarm Instalfation a Torch Roofing/Tar Kettle
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> � Fire Works
<br /> Flammable Application-ANNUAL
<br /> Valuation of Project
<br /> � Fuel Tanks
<br /> � Other�
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<br /> Contractor
<br /> Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address
<br /> License#
<br /> ELECTRICIAN Company
<br /> Sigrature Registered Y/N Fee Current Y/N
<br /> Address
<br /> License�
<br /> PLUfviBER Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address
<br /> License�
<br /> McCHANICAL Company
<br /> Signature Registered Y/N ree Current Y/N
<br /> Addr=ss
<br /> License#
<br /> OTH�R 1 � _ Company 7P�/Z F'Y��' ,�jTL C7 Z� �iJ<
<br /> Signature �J Registered � Y/N Fee Curreni Y/N �
<br /> Address ,� � License� �
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<br /> Directions: "'' .. O �Q .3 c. .:....... :�,
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<br /> Fill out applicafion completely
<br /> Owner&Contractor sign back of aoplication,notarized(Or,copy of signed contract with owner)
<br /> t�over�2500,a Notice o`Commencement is required(Mechanical work over W5000)
<br /> Suoply two(2)sets of drewing�with applicable documentaiion
<br /> Aliow 1 G-�4 days for revi=w after submittai date Paroel r-obtained from Praperty Tax Notice(nttp:/iappraissr.pascoaov.com)
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