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s��•,sc-oozo Ciiy oi Zephyrhilis Fire Fax-813-78C-0021
<br /> Permit Appiication
<br /> Dats Received � � Pho Contact ror Fermi
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<br /> Owner's Name � � +�tl1�TS �, —, Owner's Phone Number � `�� �
<br /> Owner's Address SgC� Vr�L % L . .J�O W�,57' r�F1l.,r►� �j�/�Gµ �(� ���{d
<br /> Fe=Simole Titieholder Name Titleholder Phone Number �� �� �
<br /> Fe>Simple i itl=nolder Address
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<br /> Job Address ��jl�y�� ��L�„L� D�KS +Z Lot r f���
<br /> Sub Division Parcel�
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<br /> � Bio-Hazard Waste Storage-ANNUAL � Fumioation Tent ' """ ' ' `.YYU-'^ V�FF,.
<br /> � Comm Exhaust Kiichen HoodlDuct � Hazardous Material(Tier II or RQ racility)ANNUAL
<br /> � Controlled Bum � Hood Installation
<br /> � cmergency Generator<30 Kw � LP/Naturel Gas-Installafion
<br /> � Emergency Genereior>30 kw � LP/Natural Gas-ANNUAL Sale
<br /> '� Fire Protecfion Maintenance-ANNUAL � Places of Assembly-ANNUAL
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<br /> Spnnkler ❑ ❑ `� � � Recreauonal Bum �(,����,
<br /> Fire Alarm � ❑ ❑ � � � Sparklers � /
<br /> Hood Cleaning � � ❑ ❑ � � Sprinkler System Installations
<br /> Hood Suppression � ,_r', ❑ ❑ �� � Standpipes(Sprinkler SysJ
<br /> � Fire A�arm Instailation � Torch Roofing/Tar Kettle
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> � Fire Works
<br /> � Flammabie Application-ANNlIAL Vafuation 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
<br /> Company (
<br /> Sigrature Registered Y/N Fee Current Y/�1
<br /> Address
<br /> License�
<br /> PLUMB�R
<br /> Company
<br /> Sigrature Registered Y/N Fee Current Y/N
<br /> Address
<br /> Licensa#
<br /> M�CHANICAL Company
<br /> Signature Registered Y/N Fe=Curren? Y/N
<br /> Address License#
<br /> OTH�P, • Company -r�c-iZ ,C7/�r` C 2G7�GTTCJhJ .�-/�c�G
<br /> Signature Registered I �/N ree Current N
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<br /> Directions: __,.,_,......�a_ ._._ ,, _._. .�-_..�._.x.�..:....,,_._,.:,.� .._.__ <<,,,.
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<br /> Fill oui application completely .� F(�Q O 1 r�. ���
<br /> Owner 8 Contractor sign back o`aoplication,no:arized(Or,copy of signed contract with owner)
<br /> f�over 52500,a Notics o.`Commencement is required(Mechanical work over W5000)
<br /> Supply two(2)sets o`drawings with applicable documentaiion
<br /> Allow 1 G-1�tiays ior r=view after submittal aate Parcel�-ob,ained from Property Ta>:Notice(http./fappraiser.pzscogov.com)
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