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` - - �- "s�3-�so-aa2o Gity of Zep yrhills Fire Fax-sis-7aaooz�
<br /> Permit A plication A�L�X
<br /> Date Received ��� Phone Contact for Aermit $�3 �+�� �3�
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<br /> t}wner's Name (T�,•'r tf{�+T '� � E��7 �"� Owner's Phone Number �� �� �
<br /> ownar'sAddress �� X �b� t3ENTONVIl.Z,E I� �01 �► �
<br /> Fee Simple Titleholder Name Titleho�der Phone Number �� C� ��
<br /> Fee Simpie Titlehoider Address
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<br /> Job Address ___<. ��.,.�V��_.._.C�(T� �v� ����l� ��� �`. Lot#
<br /> Parcel# 3y���� �t "'di��� �'aat8
<br /> Sub Division • �
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<br /> `� 8io-Nazard Waste Storage-ANFlUAI � Fumigation Tent
<br /> � Comm Exhaust Kitche�Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL
<br /> � Controtled Burn o Nflod Installation
<br /> � Emergency Generator K 30 kw a LP/Natural Gas-Installation
<br /> � Emergency Generator>30 kw o i�PlNaturai Gas-ANNUAL Sale
<br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL
<br /> Qtrly em� nl t er ��
<br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum l�
<br /> Fire Alarm � fl 0 0 � � Sparklers ���
<br /> Hood Cleaning � ❑ ❑ ❑ � Sprinkler System Instailations
<br /> Hood Suppression � d � C7 � Standpipes(Spr{nkler Sys)
<br /> � Fire Alarm Installation � Torch RoofinglTer Kettie
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> � Flammable Application-ANNUAL C��•�i� Valuation af Project
<br /> � Fuei 7anks '
<br /> � Other� �. .., .. >. �
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<br /> Contractor N m Y x ' ^^- �Company �
<br /> Signature Registered Y(N Fee Current Y/N
<br /> Address License#
<br /> E�ECTRICIRN Campany __ �,,,_�
<br /> Signature Registered �Y/N fee Current Y/�
<br /> Address License#
<br /> PLUMBER Company r ^� _ �
<br /> Signature Regisiered CY/N Fee Gurrent Y/�—
<br /> Address License#
<br /> MECHANIGAL Company �
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Rddress License#
<br /> OTHER `��'� V �VQ/l��I") M��� Company 0��� Ft�� �Jp'�I11�k�.�r'i�/�.f
<br /> Signature .� � Registered Y/N Fee Current Y 1 N
<br /> Address ��(� � W/9` VE S�7/T � iR'� License# J �Q��l 00 µ A. i.V V
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<br /> Directions: _. _ _ . _ _,.._�_ .._ . ---.. �._
<br /> FiII out application completely.
<br /> Owner 8 Contractor sign back of applicatian,notarized(Or,copy of sign d contract with owner)
<br /> tf over$25RQ,a tJotice of Commencement is required{Mechanical work ver$5��0)
<br /> Supply two{2)sets of drawings witfi applicabte dacumentatian
<br /> Allow 10-14 deys for review after submittal date. Parcel -nbtained from Property Tax Notice(http://appraiser.pascogov.com)
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