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<br /> 893-780-d020 Clfy Of ZB�IhyfhillS Ft�@ Fax-893-784-4021
<br /> ' � Permit Application
<br /> Date Received �+ ��/�Z,�'�� Phone Contact for Permit �� � ��
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<br /> Omte�s Name � �� � �C 1 -S � Owne�s Phone Number p � 3 �/ � b �� `
<br /> O+rmer's Address ��� �Gf'��� /V� W C7 �
<br /> Fee Simple Titleholder Name _ Titleholder Phone Number �� � �
<br /> Fee Simple Tit3eholder Address
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<br /> aob aaa�ss Lfft# ��
<br /> Sub Division Parce!#
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<br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent
<br /> � Gomm Exhaust Kitchen HoodtDuct � Hazardous Material{Tier 11 ar RQ Facility}ANNUAL
<br /> i � Cantroiled Bum � � Hood Installation
<br /> '� � Ernergency Generafor<30 kw Q I.P/Natural Gas-Instailatian
<br /> � Emergency Generator>30 kw o LP/Natural Gas-ANNUAL Sale
<br /> I� � Fre Pmtection t�Aain#enance-ANNUAL � Places af Assembly ANhlUAL (,.'') �� �
<br /> � emi � er, '%� f 1
<br />� Sprinkier � O O ❑ � Recteationai S'um
<br /> I Fire Alarm � ❑ d ❑ � Sparklers
<br /> Hood Gleaning � ❑ ❑ 0 �� � Sprinkler System Installations
<br /> Hood Suppression � ❑ Cl ❑ � � Standpipes(Sprinkler Sys)
<br />� � Fire Alarm Installatian Q Torch Raofingfiar Kettie
<br /> � Fire Pumps ,. � Waste Tire Storage ANNUAL
<br /> � Fiammable Application-ANNUAL r � , Valuation af Project �
<br /> � Fuel Tanks .
<br /> � Other:
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<br /> � Contractor Company
<br /> , Signature ` Registered Y/N Fee Current Y/N �
<br /> Address I�cense# t
<br /> ELECTRICIAN � Company
<br /> Sigrtature Regisfered Y 1 N Fee Current Y 1 tV
<br /> Address License#
<br /> PLUMBER Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address Gicense#
<br /> MECHANIGAL Company
<br /> Slgnature Registered Y I iti! Fee Current Y/N
<br /> Address License#
<br /> OTHER Company
<br /> Signature Reg�stered Y!N . Fee Curzent Y!N
<br /> , Address License#
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<br /> Directions:
<br /> � Fill out appiication compietely. .
<br /> Owner&Contractor sign back of application,notarized(Or,copy of signed contract with ovmer)
<br /> it over$2504,a Notice af Commencement is required{Mechanical work over$500Q}
<br /> Suppiy twa(2)sets of drawings with appiicabie documentation
<br /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(httpJ/appraiser.pascogov.com)
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