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e�saaaooso City of Zephyrhilis Fire Fax-s��-�so-oo2� <br /> Permit Application <br /> Date Received Phone Contacx tor Pertnit ��� Q y� �4 4 3 <br /> - - ,. _..n, . . s - _-._ <br /> �e. ei��e� ��� �t� -�ar�.:���:,� �,� — - =-"_.- , <br /> Owner's Name ' ✓� NUCJ S/NG- pwners Phpne Numbe� � �� � <br /> Owner's Address Po go x i 7 F� L�Tz �'L 3.3 S f�� - oi 7� <br /> Fee Simple Tiqeholtler Name Titlehold@r Pho�1@ Number � � C] <br /> Fee S�rrple TiGehottlerAdd�ESs <br /> , <br /> . v - _ <br /> __ ...-���';"�';;� " -.��"ew�.�-°`��r: - .,.. ._- - ��,.. <br /> �a:.�:::.:..4_c:..�'" ' .:�.'"r—�.:.sx�._:z:-..�> . <br /> Job Address �9 3 7 'y�O/C.4G V/Eu/ G/�/ ZEP�'Y�ti�c�S, %L 33.�y t.ot# C� <br /> Sub Division �� <br /> .._._.._,.._.. ........_ ,..,.. _.� .._ . . ,. _ . _.., , <br /> �-�.:�-�.�`��-�-.s�� –��a•.� �;- _.;-•_w_3::���:�._,.,.. ... <br /> � ' Bio-Hazard 1Maste Sra�age-ANNUAL a Hazard0us Material(Tier II or RQ Faatity)ANNUAL <br /> � Comm Exhaust Kdchen HaodtDuct � Hood InshdllaUon <br /> � CorriroAed Bum _ � lPlNatur2l Gas-Insfeliation <br /> � Emergency Generator<3p kw � LP/Natural Gas-ANNUAL Sale <br /> � Emergency Genentflr>30 kw a Places of Assemby,ANNUAL <br /> � Fire Probedion MaiMertance-ANNUAL Q Recreatlonal Bum <br /> � emi � r <br /> Sprinkler � ❑ ❑ D � Sparklers <br /> Fire Alarm � ❑ D � � ❑ SprinWer System Indailations � �( 3 <br /> Hood Cl�ning � ❑ � O � Standpipes(Sprinkkr Sys) <br /> Hood Suppresaion � •O ❑ ❑ � Torch Roofingl'Tar Kettle <br /> � Fire Alarm Instelk�tion � Waate TirE StotBge ANNUAL <br /> � Fire Pumps <br /> Fire Wbrks <br /> � F�ammae�e�ii�ior,•nNwua. Valuation of Project <br /> Fuel Tanks <br /> � Other. <br /> _�.. _ W. <br /> , .. . _.....�.:��l��x��� ra��*�* �K�,..,�., ----_R.:......�;�:�_.�:yu_:._ . <br /> contrador ,_--- Company T 1 I 'o � <br /> Signature RegisEerod Y%N Fee Current Y!N <br /> Address 3 5 31 K t �en� Ra. ucense# F 000 '�� <br /> ELECTRICIAN Company <br /> s�gnature Registered Y/N Fee Current Y/N <br /> l+ddress Licenae# <br /> PL'JMBER Comp2ny <br /> s�gnature Reg'istered Y/N Fee Current Y 1 N <br /> Address LiCBnS@# <br /> MECHANICAL COmpany <br /> Signature Registered Y/�) Fee Curttnt Y/N <br /> Address LicenSe# <br /> OTHER COmpeny <br /> S�gnature Regiatered Y/N Fee Current Y/N <br /> Address Uce�se# <br /> :;:,:�_;ctF.;..� - . : —,__.�._ w.��.- --=-- � - - �.�.....�.=—=--_—..�._,. . , <br /> ;�".m:_� ;�z� � • � . - �. �-,. ..�..:.::�:_..z.. ...... � <br /> Directions: - <br /> Fill out appliCption Completdy. . <br /> Ovrnef 8 COnVac�or Sipn bedc of aPP�icati0n.notarized(Or.coPY of signed contract with owner) <br /> If over 52500,a NoGce of Cortunencement is required(MeChaniCal work over S500G) <br /> SuDpIY two(2)sets of drawin9s with applipble documenta�on <br /> At1ow 10.14 days for review atter submittal date. Parcel#-obtained from PropeAy Tax Notice(http_//appraiser.pascogov.com) <br />