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81�780-0020 Ci'ry ofZephyrhilis �ire Fax-8'3-780-OC21
<br /> - Permit Application
<br /> Date R=ceived _� � Phone Contact for Permif 7,� �] a5 (�F"
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<br /> Owner's Name �(J 1 (7L r T LL L Owner's Phone Number � C� ��
<br /> Owner's Address -{(�0� (,(,E:(,C,S �Ai2G,j) C, T�s' / p 5 ��s.I �)�!y'cici7 L ry
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<br /> ree 5imple i itlehold=r Name Titleholder Phone Number � �
<br /> Fee Simple Titieholder Addr=ss
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<br /> Job Address �l O �.j� r1�L l J" f��ti Lot€
<br /> Sub Division �
<br /> Parcel,= � _v —d b p
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<br /> � Bio-Hazard Waste Storege-ANNUAL � Fumigation Tent
<br /> � Comm Exhaust Kitchen HoodlDuct � Hazardous Material(Tier II or RQ racility)ANNUAL
<br /> � Controiled Bum � Hood installation
<br /> � cmergency Generator<30 kw � LP/Natural Gas-Installafion
<br /> � Emergency G=nereior>30 kw � LP/Natural Gas-ANNUAL Safe
<br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL
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<br /> Sprinkler � ❑ ❑ �.. Recreafional Bum
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<br /> Fire Afarm � p O ❑ � � Sparklers �
<br /> Hood Cleaning ;, p � �
<br /> ❑ C� � Sprinkler 5ystem Installa:ions
<br /> Hood Suppression � C� ❑ ❑ � � Standpipes(SprinklerSys)
<br /> � Fire Alartn Instailation � Torch Roofing/Tar Kettle
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> � Fire Works
<br /> � Flammable Application-ANNUAL Valuation of Project
<br /> � Fuel Tanks
<br /> 0 Other:
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<br /> .. ......... ..... ...........�..._.x.:NJtet: ��ii•..fiF`.:� x:.tv^ i �i'711�1r. _ -
<br /> Contrector _. _;,:;�r:._. �, .. �_..:�;-.^._"x.:'p`�.�:uxs"F':�'L::�';s"v�,x��r: n an;. K_ '.Grxvr ..
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<br /> Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address
<br /> License�
<br /> ELECTRICIAN
<br /> Company
<br /> Signaiure Registered Y/N Fee Current Y�N I
<br /> Address
<br /> License#
<br /> PLUNiBER
<br /> Company
<br /> Signature Registered Y/N Fee Current Y/N �
<br /> Address
<br /> License#
<br /> McCHANICAL
<br /> Company
<br /> Signature Registered Y/N Fe=Curren+, Y/N
<br /> Addr=ss
<br /> License�
<br /> OTH�P, ,
<br /> Signature
<br /> Company �Z E/� �-r.E'_a I��orcC rla.c� �� •
<br /> Registered � (�/N Fee Current N
<br /> Address O , L.A2G.D - L
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<br /> •. ..:_...,: u. ..._.._...__._, . ? License� �
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<br /> a3e�o , � 9
<br /> Directions: _.. ._ . .._.. _,_<_.�..<,�.�.�,..�...�.«.,.._�_._.., .. - - , .. .__. ._....x. .....,.... _ > -
<br /> Fill out applicaiion completely � �
<br /> Owner&Contrector sigr,back o`application,notarized(Or copy of signed contract wrth owner)
<br /> G over�250G,z Notice o.`Commencement is required(Mechanical work over�5000)
<br /> Supoly two(2)sets of drawings with applicable documentaiion
<br /> Ailoti�1 C-1�days for revi=w after submiTal aate Parcel�-obtained from Property Tax.Notice(hrp://appraiser.pascoaov.com 1
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