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' s�saso-oczo Ci'ry of Zephyrhilis Fire Fax-8�aaso-oczi
<br /> � Permi:Applicafion -
<br /> Dat=R=ceiv�d � I _ _ PhoneFContactz or Permit �-Q_�--�
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<br /> Owner's Name {-��i ' ►-,-, �/U sJ Pc / Owner's Phon=Number, � � �
<br /> Owner'sAddress ��= �- LL _ � • � C
<br /> Fee Simple Titleholder tJame Titieholder Phone Number � �
<br /> ree Simple"fitleholderAddress
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<br /> Job Address~. f. . �` (J� '_ I!H - � Lot t �
<br /> Sub Division Parcel,= ��— `�� -^ �� •� �)
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<br /> � Bio-Hazard Waste Storege-ANNUAL � Fumiaation Tent
<br /> a Comm Exhaust Kitchen HoodlDuct � Hazardous Material(Tier II or RQ"racilitvl,,At�lN11AL
<br /> � Controlled Bum � Hood tnstallation r''�� �`�
<br /> � cmergency Generator<30 kw a LP1Natural Gas-Installafion
<br /> � Emergency G=neraior>30 kw � LP/Natural Gas-ANNUA aie ��J��
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<br /> Fire Protection Maintenance-ANNUAL � Places of Assembly-AN UAL
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<br /> Sprinkler � ❑ ❑ � � Recreational Bum
<br /> Fire Alarm � ❑ G '�- � � Sparklers
<br /> Hood Cleaning � u ❑ ❑ � � Spnnkler Systam installations '�
<br /> Hood Suppression � G ❑ ❑ � � Standpipes(Sprinkier Sys)
<br /> � Fire Alartn installation � Torch RoofinglTar Kettle
<br /> a Fire Pumps � Waste Tire Storage ANNUAL
<br /> � Fire Works
<br /> � Flammable Application-ANNUAL �_ —� Valuation of Project
<br /> � Fuei Tanks
<br /> � Other•
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<br /> Contrector Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> cL�CTRICIAN Company
<br /> Sigraiure Registered Y/N Fee Current Y/N
<br /> Address License�
<br /> PLUMBER Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> McCHANIGAL Company
<br /> Signature Registered _ Y/N r=ee Curren! Y/N (
<br /> Address License�
<br /> OTH�R � �y Company �=p�� �=T��� 1�i�a i�„[r�o.U, S�U c ,
<br /> Signature ��1 JV„ \1� /L-�y Registered /N Fee Current Y/N
<br /> Address , � , �L �3�'7 `7
<br /> License# C7� � c
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<br /> Dvections:
<br /> Fiil out application completely
<br /> Owner&Cont;actor sign back or apolication,notarized(Or,copy of signed contract with owner)
<br /> f�over�2500,a Notice o`Commencemen,is required(Mechanical work over W5000)
<br /> Supply two(2)sets of drawings with applicable documentation
<br /> Allow 1 C-14 days for r=vrew after submittal date Parcei r-ob,ained from Property Tar.Noti�e(nttp:/iappraiser.pascoao�.com)
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