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s���sa-oo2o City of.Zephyrhifls Fire <br /> 'Permit Appfication Fax-8�3780.0021 <br /> Date Received <br /> � "'.�"�."'�.:"��%'�"*��"����•�. Phana Contect fer Pertnit S' ����� ,=� <br /> owner's'Name r c���� ��� 6_ <br /> Oamer's Phone Number � G z �—y <br /> Ovmer's Address y�� L` � A ��,p�> , / ,� �G ����/ <br /> tJ l Gd- �.�� <br /> ree Simple Titieholder Name � � � <br /> Titleholder Phone Number <br /> rAe SimpleTitleholder Address <br /> S'�"E� _ <br /> JobAddress �L� � Gf�.L,L ��j/� � ��1� � <br /> ��t�r �� 3 3 s�� �ot# <br /> Sub Division <br /> ,, Parcel# <br /> aBio-Hazard Waste Storage-qNNUAL � <br /> � Fumigatlon?ent <br /> Comm Exhaust Kitchen Hood/Du�t Hazardous Material <br /> � � (Tier II or RQ Fa�ility)ANNUAL <br /> Controfled Bum Hood Inste{lation <br /> � crr�etg�r�cy uen�ratar<3C nn� r"'1 <br /> � � LP/Natural Gas-Instaf!atior. <br /> Emergency Generator>30 kw LP/Natural Gas-ANNUAL Safe <br /> � Fire Protection Maintenance-ANNUAL � <br /> Places of Assembly-ANNUAL <br /> ❑�r� emi A'(�n er � <br /> 5prinkler ❑ ❑ ❑ Recrea+ional Bum <br /> Fire Alarm � ❑ ❑ O r--'I � <br /> ;� �___,__� Sparklers <br /> ood Claaning <br /> � � ❑ ❑ C� � SPrtnkler System Installations <br /> Hoo unpression ❑ ❑ ❑ � � Standpipes(5prink►er Sys) <br /> � Fire Alarm instailation � Torch Rooflng/Tar Kettle <br /> Fire Pumps � Waste i ire 5torage ANNUAL <br /> Fire Wori<s <br /> Fiammable Appiication-ANNUAL ���• <br /> � Fuel Tanks � � Vafuation of Project <br /> ��. <br /> � Other: <br /> Contractor <br /> Signature Comparry � �� �.--Y <br /> Address Registered Y N Fee Current �' � <br /> License# <br /> ELECTRICIAN <br /> Signature Company <br /> Registered I T �ry � Fee Current Y/N <br /> Address <br /> License# <br /> PLUMBER <br /> Signature Company <br /> Registared Y/� Fae Curtsnt Y 1 N <br /> Address -----.: <br /> License� �-I <br /> MECHANICAL <br /> Signature Company <br /> Registered (_Y/N� Fge Current Y/N <br /> Address <br /> License# � <br /> OTHER <br /> Signature Company <br /> Registered L Y/NJ Fee Current Y/N <br /> Address <br /> Dtrections. <br /> ,� License# <br /> Fil out application completely. <br /> �., <br /> Owner&Contractor sign back of appiication,notarized(Or,copy of signed contracY with owner) <br /> If over$Z5DQ,a Notice of Commencament'rs required(Mechanical work over$5000) <br /> Supply two(2)sets o{drawings with app�icable doeumantaUon <br /> Altow�p-1 a days for review after submittal date. Parcel#-obtainad from Property Tax NoUce htt //a <br /> � P: ppraiser.pascogov.com} <br /> . . � � <br /> �� <br /> - - 1 t <br /> r <br /> � : <br /> _ _. � � <br /> ' � � I <br /> il <br />