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s�3-�so-oo2a Ci ofZe h <br /> tY p yrhilis Fire Fax-8�3-7so-op2� <br /> �are Rece�ved Permit Appiication <br /> __�� . ", Phone CoMact for Pertnft � <br /> _ / <br /> Owners Name ryqLrY�A 4J� _ ' <br /> Owner's Phone Number C� � �� <br /> Owners Address z ,l tl 3�3 <br /> Fee Simple TiUeholder Name <br /> Fee Simpie TiYlehdder Address Tiuet'°�de�P►���ber <br /> :�.r^s*��"��r��c, <br /> Job Address 3 ` L �\ 7 <br /> .r,� G e ` � r/ 33S � <br /> Sub Dtvislon Lot# <br /> :�'+' � Pam.el# <br /> � Bio-Hazard Waste Store __ - <br /> � 98-ANNUAL � ---- - <br /> Comm Exhaust Kitchen Hood/Duct Fu�tlon Tent <br /> � ConUoNed Bum � Ha��OUS��I(Tiar II or RQ FacN(ty)qpNUAL <br /> QEmeaJBncY Generator<30�, Hood Installation <br /> � Emergency Generator>3p Icw, � �P����Gas-installa6on <br /> aFire Protecdon Maintenance-pNNUq� � LP/Natural Gas-qHNUAL Sale <br /> m � Places of Asaembly-ANNUAL <br /> Sprinkler � <br /> � � ��� <br /> Flre Alarrn � 0 � O <br /> � RecreaUonal Bum <br /> Hood Cteaning ❑ � � Q � � SP�rklers ��i/ �l �,./ <br /> ,�7 � c/ <br /> ❑ � C� SPR�We►SYstem Installallons ( <br /> Hood Suppressb� � � � ❑ <br /> Q Flre Alartn k�stal�aUon StandPipes(gP�nkler Sys} <br /> a Flre Pumps � Torch Roofing/Tar Kettle <br /> �re wo�xs Q wes�r�s�o�e n�un� <br /> Flammable Application-ANNU,qL <br /> Fuel Tanks ���-� Valuation of Project <br /> QOther: <br /> Contractor <br /> 5lgnature <br /> �O"�^y �l 1� <br /> Address ��St°^� Y� Fee Curtent Y/N <br /> ELECTRICIAN 's License# <br /> Signature �m��y <br /> Address Re9istered Y/N Fee Current Y/N <br /> PLUI�ER Licer�se# � <br /> Signature ���Y <br /> Address Reg�stered Y!N Fee Currant Y/N <br /> MECHANICAL License# ----� <br /> Signature Comperry <br /> Addross Re9�gtered Y/N Fee Current Y/N <br /> OTHER Ucense# � <br /> Signature �pa�y <br /> Address �9�stered Y/N Fee Current Y/N <br /> Directions: License# <br /> Fill out application completely. . <br /> Owner&Contractor gig�(�ck of applicaUon,notarized(Or,copy of si�ned contract uyith own�� <br /> If aver 52500.a Motke of Commencemern is required(Mect�anical work ov�r�ppp <br /> Suppiy two(2)sets of drawings wiyi applicable documentetion � <br /> Allow 10.1 b deys for review after submittal date. <br /> Parcel#-obta(ned from PropeAy Tax Notice(http!/appraiser.Pescogov.com) <br />