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913-780-0020 City of Zephyrhilis Fire Fax-813a80-0021
<br /> Permit Application
<br /> Date Received �I �r� v�D I L� �� a r 7
<br /> ,�..��� . �,..:� ���.��,,;,,,�, .: . ,.,. . y Phone Contact for Permd �rt,
<br /> . 4 ,-{.� . ��-�,���<,..
<br /> Owner's Name D�?.Yt � � ,(,.,/.�'j Owners Phone Number 1 ',L, J( ��
<br /> �k>�D �j�'l s �_h�{-�'.�' C`S �re.Fy-,
<br /> Owners Address � /Y���?l1��f(:;,ma ,��jl��°?2' ��J3
<br /> Fee Simple Titleholder Name Titleholder Phone Number C] �� ��
<br /> Fee Simple Titleholder Address
<br /> K,Nt�<�� „�x ,� ��y�.
<br /> Job Address x�l..��� ���"f'� �c�F^�� '2c�i �".(o�tr��'i'�.i���� F�� 3 J��`T n ��
<br /> Lot#
<br /> Sub Division .��r�{-t n T � �� �'v2���S v �� � �� r
<br /> �..�:«���,��,;���,�,�,�
<br /> � Par�ei# ��-�-y-1 - nc�!C�, �O I I r�c�-oocx�
<br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent
<br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier 11 or RQ Facility)ANNUAL
<br /> � Controlled Bum � Hood Installation
<br /> aEmergency Generator<30 kw � LP/Natural Gas-Installation
<br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale
<br /> 0 � �,
<br /> Fire Protection Maintenance-ANNUAL Places of Assembly-ANNUAL /1�
<br /> � emi � er l i
<br /> Sprinkler � ❑ ❑ ❑ � � Recreational Burn ( �
<br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers �
<br /> Hood Cleaning � ❑ ❑ ❑ � �Sprinkler System Installations
<br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys)
<br /> � Fire Alarm Installation a Torch Roofing/Tar Kettle
<br /> � Fire Pumps a Waste Tire Storage ANNUAL
<br /> aFire Works
<br /> � Flammable Application-ANNUAL °Q V'aluation of Project
<br /> Fuel Tanks
<br /> Q Other: �.�p��p,,
<br /> .nWSaa*.� ar.�� _
<br /> Contractor Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License# �—
<br /> ELECTRICIAN Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License# �—
<br /> PLUMBER Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address I—'—
<br /> License# �_
<br /> MECHANICAL Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> OTHER Com an
<br /> P Y I E�` �'C'f"7 _ � , '
<br /> Signature � .:�J��' ��, �`z/�,�/`,��f� � ef'].� Registered Y/ Fee Current Y/N
<br /> Address '�t�Ij.� P.;��.C'/�)jqQ,�1����C� f�.�ry F�-, - • license# Q �.. ' �- r F'
<br /> �a�;,� „�,��, . .�
<br /> . .. ... . ... . .. , .. . .. .�.. ..... . . ... .... .. .. .. .. .. •��.a..��,_*�-:�+�-..:..:... .. . . . .., ,. .... .°�a�zr..�,,,,..;�.,,.
<br /> Directionx
<br /> Fill out application completely.
<br /> Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner)
<br /> If over$2500,a Notice of Commencement is required(Mechanical work over$5000)
<br /> Supply two(2)sets of drawings with applicable documentation
<br /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com)
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