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� e���ao-ob2o City ofZephyrhilisF�=:f:.::::- Fax-sis-7eo-oo2� <br /> Petmit Appiic:ation <br /> Date Recaived Phorie ConEactior Pertnit <br /> Owner's Name t�t� ��� �. � �a .2 S Owners Phone rhunber �5�3 / C� 1 �t <br /> o��rSAda�� :��/, v �•.at�5i n v.��l u2. - li f +�� FL 33S'�1'ot <br /> Fse Simple?itleholder Name Ttdeholder Phone Number � � � <br /> Fee S�nple'TitieFmider Address <br /> �a�� i�(Ai fQ ti��t '�, h ') �3Sy� �'V I SIeE� H ��# C <br /> sub DNision r�ancel# ' <br /> � Hio-Flazard Wasts 5tprage-•ANNUAL � FurttigaH�TeM <br /> Q Camm Exhaust f�tchen Hoodl�et - � �dous Materis�(Tier��or RQ Facqity)ANNUAL <br /> a ContrnUed Bum � Hood Instailation <br /> aEmergency Ge�erator<30 kw � LP/Nadiral Gas-InslBUation <br /> oEmergency Gerterabor>30 kw � LPMahxal Gas-ANNUAL Saie <br /> � Fire Ptotechon INairrtenant�-ANNUAL � Placss oE Assembty-ANNU <br /> r �i <br /> g�ef . n� �� Rsaeational Bum �/� <br /> Rre Alarm � O ❑ O �SPa� <br /> Hood Cleaning � ❑ O ❑ SP���Y���� /�/ (�� � <br /> � �•(. <br /> H�d Suppre�ion � ❑ ❑ 0 •� a ��(�P�n�r Sys) � <br /> aFfre Alatm InstaUsUon � Tor�h RaoMg/Tar Kettle <br /> Fte Pumps � Waste Tire Storage ANNUAL <br /> Ftre Works <br /> Flammable Appltcation-ANNUAL �--� Vaivation of Project <br /> Fuel Tanks <br /> Q Other. <br /> Contractor �Pa�Y <br /> SignaWre , (�,�c,�/ ` � - Ragisterad Y/N Fee Current Y/N <br /> Address � L�canse# <br /> �crRicw � -c��r <br /> S;gnawre Regisbared Y/N Fse c:�rent Y/N <br /> Address LkkxrBe# <br /> PIUIU�FFt Comparry — — <br /> Sig�wre Registered Y/N• Fes currant Y/N <br /> Addrass ' Ucense# <br /> AAECNANI Company <br /> Signature � Reglstered Y 1 N Fee Curtent Y�!N <br /> Address •License# <br /> on�� � co�m� � <br /> Signature � Registe�ed { Y/N . rroe Gurtent Y!P! <br /> Address / Lic�nse# <br /> �d� <br /> �: – - <br /> FiU out appfleetion complately. <br /> Oumer 8 Cattr�sign badc uf appticatian.notar�d(�:caopY of signed conbact w�h owner) <br /> If over 52500,a MoUce af Cortur�nentis re�irad.(Med�t work o+�550�} <br /> Supply two(2)aets vF drawings with applicade doctnne�ation - <br /> Ailow'10-14 days for review aFEer submitlal dat$. Parcxi#-obtained irom Propecty Tau Notice(htkp://appralser.pascogov.�m) <br />