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<br />City of .tepl'1yrnnla Am .
<br />:permit Applicati~n .
<br />!>>hol1!I ,r.'.onteot for p~rmlt
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<br />-'-~~~~~~ PhQn.'Num~,
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<br />5/7
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<br />P.~1~7so.oD21 11
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<br />2008.Jan.09 09:43 AM DunnWell Facilities Services 919.661.1900 .;,~
<br />U~l"i UO/, l'. I/TJiU U4: n rM t.c.t"liY.lailLL~ HUILlHNt,; FAX No. 813-780-0021
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<br />03. te Recel~'EJ:J . r., - ~ ....-V'
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<br />owner's NSIn!;' . '~~.u-r .. ,
<br />O~el'$ Md,'nell, DE, ajl"~ 6alLJb\ {)(l
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<br />FaeSlmpl. nehold~~ame' " I' '. ' ,,' . ,.' ,
<br />Fee Slmple Tit al10lder Address '. T
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<br />, ] T~\eI'Cl:t'ler Phone Number, -[
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<br />" . . Parcel# " , . . 1
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<br />, . D FllT!'~onTent . ':'
<br />. D HlII::llT'(IOl!S Material (Tier il or ~<?- Facln~) ANN~ "
<br />, C] Hood lrl,S\Sllation ,
<br />[] 'LPINatlll'm Gall-Install~on
<br />D LPJ1'latlJlllI Ga!!-AN~IUAL. Sale'
<br />CI Fl18D!~ ~f A!lSembly-AN~UAL.
<br />C:J FlElCl'mlllonel!!JlT1, ,
<br />: CJ Spwtl~Jra
<br />'. :'.' C:J S~iil'\XPM' Syltern InlltBll8110nl
<br />C:J ~n(I~lpei (Spr1n1der sy.)
<br />C] TOldl ~DfIn;
<br />[] ~-sl:-a TIre stOIllse ANNUpJ..
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<br />Sub Olvlslo'l ,
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<br />.0 Ello-Hazard Waste Sltll'llge . ANNUAL.
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<br />o OOmm Ii.llCha~ K\tchet:l HoodlDuct .'
<br />D Controlled Bum
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<br />ISp Sprinkler
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<br />, 'Emergency GeTtel'~r, c; 30 kw
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<br />Emergency G1&n~r)> 30 k'i-' "
<br />Fire prgtfilclion'Malll;tenance - ANNUAL
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<br />CI T=uel T~"kI
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<br />:Contratmlr compzny (! ' "
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<br />Si~re . ~' 'R~9j:;tered t Y {N l' Fee cu~rrt I. Y I N l
<br />:Ad~.r I,. Ucer.1l(jllj< 1 ," 'f I'.
<br />, MEC~ANIr.:}ll[ [ company r " - .' . " . ;
<br />:Slgn~ur. . '. Reg~r:ef'B!l. l .<? I N l' Fee curr~ I Y I N I
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<br />OTHER I -, Company I '
<br />Slgn.iure L ' R~d Y I N Fee Cu~nt
<br />'Br;~~.~'~~~-' ~'7 - 1 - ~.L.!!~~~) -- --~<
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<br />l::or outapplicatlo'n completeiY.'. '.. " .,.. , '
<br />OWner II< CClmraoicr sign back'of application. 'notarlzed (Or, CDPY d :Dgnw ~ct with owner)
<br />Jf over $2500, a, No1lllll of ColTU'tleneement 11 requIred (Meohanloal'f,ork O\flf E1S0DO)
<br />Supply twg (2) setS of drawings:w1lt1 applicable dooumsrrtsllon
<br />Allow 10-14 deya for mi.w ~ SUbmittal date.
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<br />1 ' Valuatior o~ P'rtlj~ot .
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