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813-78Q-002Q City of Z@phyfhills Fire Fax-913-780-0021 <br /> Permit Appiication <br /> �... . . .,,_.._ <br /> Oate ReceRred ` • � Phone Contact for Permit <br /> ��.�.�.., _ .. . . 4�.+���..R.,.�.�-� .._�- ....,,,�.,�.��:�..�.�=z.,_�.�,4��.r,-.-:.-,..��.4..� <br /> Owner's Name /�C? Owner's Phone Number �f � � <br /> Owner's Address ��� (� 1!' L° � � � � � � � <br /> Fee Simple Titleholder Name Titleholder Phone Number �� �� � <br /> Fee Simple Titleholder Address <br /> �-�-;��:.�•�:�.:_:�,��w.�_.��,�� - s� ��sr _ � <br /> Job Address Lot# �� <br /> Sub Divisian Parcel# <br /> ��-:�:.E-r�,� .�r�.�>-�.._ a� , w���.x��*y�-�As����-�w�;�,he=..�,�;x��=;�=���,���-�.�1�:�iu..,er� , , .. . � <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> o Comm Eashaust Kitc#�en HoodlDuct Q Hazardous Material(7ier II or RQ Facility)ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator<34 kw o LP/Natural Gas-Installation <br /> � Emergency Generator>34 kw � LP/Natura�Gas-ANNUAL 5ale <br /> � Fire ProtecUon Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> � emi �n er <br /> Sprinkler � � ❑ ❑ � Recreationai Bum <br /> Fire Alarm � ❑ � ❑ � � Sparkiers <br /> Hood Cleaning 0 ❑ � Q Sprinkler System Installations ��/� <br /> Hood Suppressian ❑ ❑ � � Standpipes(Sprinkler Sys) '"� �/ <br /> j t <br /> � Fire Alarrn Installatian � Torch Roofing/Tar Kettle <br /> QFire Pumps � Waste Tire Storage ANNUAL � ��( _ <br /> Fire Works `�� <br /> � Flammable Application-ANNUAL Valuation of Project <br /> .�.� <br /> QFuel Tanks <br /> Q Other: <br /> �,. ,.: ,_ . ���:,-;.��;;�,��.,;:-�:.m � . �,�:-� . �:����.a�r,. r.�;�.»��.�_ , � ��:�:_. <br /> Contractor (("� � �C'.j S (.°�` ��O ,_ ..- f�-• Company (�i <br /> Signature Registered Y 1 N �ee Curcen# Y!N <br /> Address license# <br /> EIECTRICIAN Company <br /> Signature Registered Y/N Fee Curtent Y/N <br /> Address License# <br /> P�t1MBER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Rddress License# <br /> MEGNANICA� Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address license# <br /> dTNER Company <br /> Signature Registered Y!N Fee Cunent Y/N <br /> Address license# <br /> *�:. __�: � �-,M,-.. :. _ rt_ . .,,. ., ., , r_. , _ .._ . ... .. . ,,_ » �:_ .�, . __ .. - x. . <br /> Directions: <br /> �i!!aut appiicatian compietely <br /> Owner 8 Contractor sign back of application,notarized(Or,capy of signed contract with owner) <br /> H aver$2500,a Nokice of Cammencement+s required(Mechanicai work over$5006) <br /> Suppty twa(2}sets n#drawings with appiicabie dacumentatian <br /> A{tow 14-14 days tor review after submittal date. Parcel#-obtained from Property 7ax Notice(http://appraiser.pascogov.com) <br />