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5��,-�so-oo2o City of Zephyrhi(ls�ire Fax-aisaac-oo��
<br /> Permit Application
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<br /> �,h,�:s vame �/1?�'� 0/A/1` �Il��hZlG- - - — Owner's Pnone Number ��3 ��{� .�{79CS �
<br /> �w^e�sAdd�ess 39(OQ'� mE7'�YSTGI/qyZ�O�Ye�i�eS �L ?l3�J�0 —�'
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<br /> -e_S�mp�e T,tleholoer Name TrtIen0lQer Phone Number '
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<br /> � Bio-Hazard Waste Storage-ANNUAL a Nazardous Material�er II or RQ Facility)ANNUAL
<br /> � Comm Exhaust Kitehen HoodlDuct � Hood InstallaUon
<br /> � Controlled Bum � LP/Natura!Gas-Instaliation
<br /> � _^��rgency Generator<30 kw �� LPlA'atu!al�as-ANNUAL Sale
<br /> � rmergency Generator>30 kw � PiaCes of Assertlbly-ANNUAL
<br /> � Fire Protection Mainlenance•ANNUAL � ReueOUonal Burn ��}�
<br /> � em� n-1 er ' �(J �
<br /> Sprinkier � p ❑ � � ❑ Spatkiers 1 1 l
<br /> Fire Alarm � ❑ D �� � $prinkler System instailations -/ ,
<br /> Hooc Cleaning � C G O � � Smndpipes{Sprinkfer Sys) �r/
<br /> Hooc Suppression � O � O � D 7orch Roofin
<br /> � gJTar Kettie
<br /> fire Alarm InstaltaAon �� Waste Tire Storafle qkNUAI
<br /> � Fire Pumps
<br /> Fir2 Works
<br /> � Fiammable Applicabon-ANNUAL �""'—'�'—�
<br /> �_ Valuation of Project
<br /> � Fue!Tanks �'�
<br /> � Other.
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<br /> Re9istered Y/N Fee Current Y!Pt
<br /> :�.cdress 3 5 31 K e J.1�o�� Rd.
<br /> �icense# F 00 �!t
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<br /> ;;�r�-e � � Company `____� _ 1
<br /> ` �--- Registered Y/N Fee Currem Y 1 N
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<br /> S�,cr.a,u,� Company
<br /> Registered Y 1 N Fee Currant Y 1 t�! I
<br /> Atioress
<br /> L,cense#
<br /> .,�,`ur� � Company —
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<br /> Registered Y C N Fee Current Y/NT--
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<br /> `,n out application compietety. ._.
<br /> Own2r$�antractor Sign back of appiicapon,notarized{pr,�py of signeo conV�ct with awner)
<br /> i�over S250D,a Notice of Commencement.is required(MechaniCal work over$5000)
<br /> S�;�P�Y two(2)sets of drawings with apptiCabie docump,ntation
<br /> AIlow�0-14 days for reView aft8r SUbfn'ttt2!ddte.
<br /> P�r��#-obtainetl from Property Tau Nolice(http://appraiser.pascogov.com)
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