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r�m 01/10l2014 13:34 #593 P.001/002 <br /> 81&78Q-0020 City Of ZpphyPhIIIS�IfB Fax-81378U-0021 <br /> Permit Application <br /> Dete Received Pr,one ca�aa ror Pem,lt " S <br /> Owner'a Name r7 C�L� Owner's Phone Number 1,3 � � ) 1� <br /> Owner's Address 3 3 3 /v J U�/Y�� �� <br /> Fee Simpla Titleholder Name TiUehdder PFwne Numbar �� C� � <br /> Fee Simpb TitlaholderAddress <br />��JobAddress . p�� e � �/� �(� � <br /> ' Lot# <br /> Sub DlviaiC� i l' � Parcet fl V� 'o��o "..�/QOgo—��' /•�� <br /> � _1 � Bio-Hezard Wtsts Storepe-ANNUAL Q FumipeUon Tent <br /> d�/►v <br /> `� � Comm Exhaust IUtchen Hood/Duct � Hazardous Meteriel(Tier II w Rp FaclNty)ANNUAL <br /> CoMro�led Bum � Hood Instal�tion <br /> � Emergency f3enerator K 30 icw Q LP/NeWrsl Ges-Ins�llation <br /> Emeigsncy Generator>30 kw lPlNatural Gas-N�IUAL Sfk <br /> Fire Proteciion Mair�r�ce-Ai�N�KJAI g Piaces of Asaembly-ANNUAL <br /> � �� <br /> Sprfnkler � ❑ O ❑ Rearoational Bum �( G��� <br /> Fire Afartn � D ❑ O � 3parklers I l.r u� <br /> Hood Cleaning � O ❑ � Sprinkler 3ys�m instaAations � <br /> Hood seq�ress�a, � ° � ° � L J yya�v�ves tswinkler sys) <br /> aFlre Alartn Installetfon � Torch RooMglTar KeEtle <br /> Fke Pimps � Waste Tire Storage ANNUAt <br /> Fire worka <br /> Flammabie Appficatbn-ANNUAL ��� Vafuation of ProJect <br /> Fuel Tank� <br /> �] oa,er. <br /> Cor►bactor • ' Compeny e� ,s� � <br /> Sipr►awre rteglctered j 6G1 N I Fee cuRent /N <br /> Address '75 Q L license# <br /> ELECTRICIAN ��� <br /> g'°"'t"`� Rsglatorod Y/N Fee current Y/N]—�_— <br /> Address lfcensa# <br /> PLt7NIBER <br /> Compeny � <br /> �"8�"B Reg+sterod Y!N Fee Cur�,t Y 1 N <br /> �� License# <br /> MECFfl4NICAL Compeny � <br /> S�gnature Regtstered Y/N Fee curront Y/N � <br /> Addtesa <br /> Licerise# <br /> OTMER ��y � , <br /> Slynature Replstered Y/N Fea CurroM Y/N � � <br /> Addreas Lfcwise# <br /> drectione: <br /> Ffll aut appib�tlon completely. <br /> Owner fl Ca�tractor sign back of appllcatan,notarlud(Or�coPY o(signed conVect wlih owner) <br /> N over S2b00.a Notbe of Commencemsrrt Is reqWrod(Mechanical worlc over 55000) <br /> �uPA�Y two(2)sels of drawinps with appitceble docummrtaUon <br /> Allow 10.14 dayB for rsvfew after submfUal date, Paroet#-obtalned from Ptuperty Tex NoGce(Mlp9/appratser.pascogov.cpm) <br />