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s� :7so-oczo City of Zephyrhilis Fire Fax-8i3-�so-oc2�
<br /> Permit Application -
<br /> Date Receiv=d . I ` _._,+ , - ,_. �_A , _y _ " . ..^,VPhone Contact ior Permit .-,-'---��°"�"`—`-��
<br /> Owner's Name � Q�L �TS Tt� Owner's Phone Number � � �
<br /> Owner's Address Y�L� '� �-. ���°�� `�`� T ��� E�� �� ��l
<br /> Fee Simple TiUeholder Name Titlehoider Phone Number � � �
<br /> ree Simple i itlehold=r Address _
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<br /> Job�Ada�es5 ..., .... a a �.. ,' ,,�� ��?. �ot� ��
<br /> 5ub Division Parcel r -�� I - -
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<br /> � ... ._, .....<�'tCCs.�_r.,�n....>.;.-,«..��a.c.,_s-'s�7�=�+,._�5�..::W.crun�.
<br /> � Bio-Hazarci Waste Storege-ANNUAL � Fumiaation Tent
<br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Materiai(Tier II or RQ Facility)ANNUAL
<br /> � Controlled Bum � Hood Instailation
<br /> � �mergency Generetor<30 kw � LP/Natural Gas-Instaliation
<br /> � Emergency G<nerator>30 kw � LP/Naturai Gas-ANNUAL Safe J�%� }
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<br /> Fire Protecfion Maintenance-ANNUAL � Places of Assembly-ANNUAL � ���
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<br /> Sprinkler � '�- ❑ � � � Recreaiional Bum
<br /> Fire Alarm � ❑ O C � � Sparklers
<br /> Hood Geaning � G ❑ ❑ � � Spnnkler System installations
<br /> Hood Suppression � ❑ C ❑ � � Standpipes(Sprinkler Sys)
<br /> � Fire Alarm installation � Torch Roofing/Tar Kettle
<br /> � Fire Pumps � Waste Tire Storege ANNUAL
<br /> Fire Works
<br /> a Flammable Appiication-ANNUAL Vatuation of Project
<br /> � Fuel Tanks
<br /> � othsr:
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<br /> Contractor Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Addr=ss License�
<br /> ELECTRICIAN Company
<br /> Sigrature Registered Y l N Fee Current Y/N
<br /> Address License�
<br /> PLUMBER Company
<br /> Signature Registered Y!N Fee Current Y/N
<br /> Address Licens2�
<br /> McCHANICAL Company
<br /> Signat�re Registered Y/N ree Current Y/N
<br /> Addr=ss License�
<br /> oTH�� Company �,U�2 /'-�s�� /�i�CT1�7 -
<br /> Signature Registered � /N � r=ee Current /N
<br /> Address �y ��C L b -L ��7`) License� `�1
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<br /> Directions: -....._._ .
<br /> Fili out application compieteiy
<br /> Owner&Contractor sign back o`application,notarized(Or,copy of signed cont;act with owner)
<br /> I�over 5250G,z Notice of Commencemen;is required(Mechanical work over$5000)
<br /> Supply two(2)sets o`drawing=with appiicable documentation
<br /> Allow�10-1�days for review after submittal date Parcel r-obtained from Property Tax Notice(http.l;apprais=r.pzscogov.com)
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