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a��-7ao-oozo Ci'ry of Zephyrhilis Fire Fax-8;3-780-0021
<br /> , Permi±Application
<br /> Dat=Received I^
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<br /> Phone Contact ro 7
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<br /> G�vner's Name - '1'C � C�'7 �- �IU p 5 L�.., Owner's Phone Number � C] �
<br /> Owner's Address � � Zl/�1� LV� H 4'�f-F1 L� r 3� �y� , (���
<br /> Fse Simple Titiehold=r Name Titleholder Phone Number �� �� ��
<br /> ree Simple 7itl=holder Address
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<br /> Job Address ly I � � � �--IA/V� �LJ �EPH`�{-f 1Lj,5 ��. ��c5�,.�,., ~LL��
<br /> Lot t
<br /> Sub Division
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<br /> � Bio-Hazard Waste 5torege-ANNUAL � Fumioation Tent �� +
<br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ racility)ANNUAL
<br /> � Contro�led 8um a Hood Installaiion
<br /> � cmergency Generetor<30 kw � LP/Natural Gas-Installafion
<br /> � Emergency G>neretor>30 kw � LPlNatural Gas-ANNUAL Sale
<br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL
<br /> ❑ my emi Hni ner „(1,
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<br /> Sprinkler � p ❑ ❑ � � Recreational Bum � �j �j� �
<br /> Fire Alarm ❑ ❑ ,� Sparklers �
<br /> Hood Cieaning � r ❑ u � � Spnnkler 5ystem fnstailations
<br /> Hood Suppression � ❑ ❑ ❑ C� � Standpipes(Sprinkler Sys}
<br /> � Fire Alarm installation � Torch Roofing/Tar Kettle
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> � Fire Works
<br /> � Flammable Application-ANNUAL Valuation of Project
<br /> � Fuel Tanks
<br /> � Other•
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<br /> Contractor �.<.._...,:�T'�;._ .<�;.�t<*;.A..�:s':�;����;,'s.�.�.�x r%�_�;��;h��:^�:,�M�.���^-.....
<br /> Company
<br /> Signature Registered Y/N ree Current Y/N
<br /> Address
<br /> License�
<br /> ELECTRICIAN Company
<br /> Signaiur= Registered Y/N Fee Current Y/N
<br /> Address
<br /> License�
<br /> PLUMBER
<br /> Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address
<br /> Licens2#
<br /> McCHANICAL Company
<br /> Signature Registered Y/N rse Current Y/N
<br /> Address
<br /> License#
<br /> OTH�P, �
<br /> Signatur= � - Compan} ���C:r� — �,v .DT�- T 7t�,J
<br /> Reg�stered Y N Fee Current /N
<br /> Address � . � s
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<br /> Directions: -., ..-- :;... _... ,., .., __ - _ - ., .- - ...__ _��....... .w. .,_.. ,. -
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<br /> Fill out applicaiion completely - --_......_._. . . ,.,
<br /> Owner&Contractor sign back oi application,notarized(Or,copy of signed contract with owner)
<br /> If over�2500,a Notice o`Commencement is required(Mechanica!work over W50D0)
<br /> Supply two(2)sets o`drawings with appiicable docum=ntaiion
<br /> Ailow 1C-1�days for review after submittal date. °aroel r-ob,ained from Property Tax.Notice(http:/iappraise-.pascogov.com)
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