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a�s-7aa-oo2a City af Zep yrh"slls Fire �ax-s��-7so-oo2�
<br /> Permit A plication
<br /> Oate Rece;ved, ���—� Pho�e Cor�tact far Permit � C__� �___�
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<br /> Owner's Name t `l f 'C' Qwrser's Phor�e Number �� �� �
<br /> Owner's Address �'�� G✓e � � U(�
<br /> Fee Simple Titleholder Name Titleholder Phone Number �� �� [�
<br /> Fee Simple Titleholder Address
<br /> i`°'m_.�_....._.�.....,.�- - - �_.�..__ "�
<br /> Job Address � ��___�
<br /> Lot#
<br /> Sub Division Parcel#
<br /> .._�.<.':.�.-�-�°.::".....o_._o__..�,�~.�°.:..�,,,�_...,.�,n.�.�-..._�....:<...y,�_�..,.._,,.�.,.�.=.�_�.n,� _ _.�..���-�:---•--°::.:..�..��,., .�..._9_�_._,�,�~- .°°-�°rv.cw�..,,�=,.�,T...�..,...�.n_,.__.�Y_.:.a
<br /> � Bio-Hazard Waste Storage-ANNUAL � � Fumigation Tent
<br /> o Comm Exhaust Kitchen HoodlDuct � Hazardaus Materiai(Tier Il or RC2 Facility}ANNUAL
<br /> � Controlled Bum � Hood Installatian
<br /> � Emergency Generatar<34 kw � LP1Natural Gas-Instaila#ion
<br /> � ergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale �
<br /> Fire Protecfion Maintenance-ANNUAL � Places of Assembly-ANNU,4� !d�{/
<br /> �y emi � er 'v t�
<br /> Sprinkier � ❑ 4 Cl � Recteational Bum < <y( {
<br /> �,
<br /> Fire Alarm � �O � Sparklers
<br /> Naod CSeaning � ❑ ❑ � Sprinkler System Installations
<br /> Hood Suppressian � ❑ ❑ ❑ � Standpipes(Sprinkler Sys)
<br /> � Fire Alarm tnstallatian � Torch RoofingtTar Kettle
<br /> � Fire Pumps � Waste Tire Starage ANNUAL
<br /> � Fire Works
<br /> � Flammable Application-ANNUAL � �, Valuatian of Project
<br /> � Fuel Tanks
<br /> Q Othe :
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<br /> Contractor Company St,1,ti,.5 �.t ,S,Cwc. Cc,�.h,�F,�,
<br /> Signature Registered Y!N Fee Current Y/N
<br /> Address License#
<br /> ELECTRIGIAN Gompany
<br /> Signature Registered Y!N Fee Current Y/N
<br /> Address License#
<br /> PLUMBER Company
<br /> Signature Registered Y 1 N Fee Current Y!N
<br /> Address License#
<br /> MECHANIGAL Gompany
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> OTHER Company
<br /> Signature Registered Y/N Fee Current Y 1�1
<br /> Address License#
<br /> Directions.._.�.,..___.._.-_._____ _...���:. _,�.,�._._._.__.�, _�.,�.._.�.__� ___.-. __._w�a__.,,..a....A......._.__,.._.�_ -,.T_._......�_:m_._�..._..._^_.,._._e_�....._.�__�__
<br /> Fill out application completely.
<br /> Ownar&Gontractor sign back af appticafian,notarized(dr,capy of si ned contract wifh owner}
<br /> If over$2500,a Notice of Commencement is required(Mechanicat wo over$5000)
<br /> Supply two{2)sets of drawings with applicable documentation
<br /> AIIow 10-14 days for review affet submittal date. Parc t#-obtained fram Property Tax Nofice{hEtp:llappraiser.pascogov.com}
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