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<br />PennIl Ap~icatIon ..ij: ~O? ~ <br />....;;~..- +t:1~~ ~ ~~ <br />I ~ Phone""':- L~ 13111,4 <br />7.-b~'^~~\\\~\ ~ <br />I Titleholder Phone Number I II <br /> <br /> <br /> <br />I Lot# <br /> <br /> <br />Date Received <br />iJi - <br /> <br />OWner's Name <br /> <br />OWner's Address <br /> <br />Fee Simple Titleholder Name <br />Fee Simple lItIeholder Address <br /> <br />II Job Address I <br /> <br />I <br /> <br />Sub" Division <br /> <br />~i ...L <br /> <br />Bic-Hazard Waste Storage -ANNUAL <br /> <br />Comm ExhaUst Kitchen HoocUDuct <br />Controlled Burn <br /> <br />o <br />D <br />D <br />B <br />D <br /> <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Rre Protection Maintenance - ANNUAL <br />.O[9!!!l ~.~~ <br />o ooL-J <br />Oooo~ <br />~)l 0 o~ <br />Do 0 o~ <br /> <br />Sprinkler <br /> <br />Fire Alarm <br /> <br />Hood Cleaning <br /> <br />Hood Suppression <br /> <br />Rre Alann Installation <br /> <br />Rre Pumps <br />Rre Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />Contractor <br />Signature <br /> <br />Address <br /> <br />~=CLA1 <br /> <br />Address I <br /> <br />PLUMBER I <br />Signature . <br /> <br />Address i <br /> <br />:=:1'4 <br /> <br />Address I <br /> <br />OTHER <br />Signature <br />Address J <br />OlrectIons: <br /> <br />-~' ~'" <br /> <br />- <br /> <br />J <br /> <br />o <br />o <br />D <br />D <br />D <br />o <br />o <br />8 <br />o <br />D <br />D <br />t <br /> <br />= <br />I <br />=l <br />I <br /> <br />II <br /> <br />-\ <br /> <br />Parcel # <br /> <br /><1 n~'l:.lfi-"""""'~; <br /> <br />- <br /> <br />Fumigation Tent <br />Hazardous Material (Tl8r II or RQ Facility) ANNUAL <br />HoocIlnstaIlation <br />LP/NatLIaI Ga!HnstaIIatiOI <br />LPfNat1nI Gas-ANNUAL S8Ie <br />Places of Assembly-ANNUAL <br /> <br />RecreatIon8I Bum <br /> <br />Sparlders <br />Sprinkler System JnstaIIations <br /> <br />Standpipes (Sprinkler Sys) <br /> <br />Torch RoofingITar KeWe <br />Waste TIre Storage ANNUAL. <br /> <br />I Valuation of project <br /> <br />Company I <br />Registered Y/N I Fee Current I Y/N I <br />License # I I <br />- <br />Company I <br />Registered Y/N I Fee Cunent I Y1N I <br />License # I I <br />Company I <br />Registered Y/N I Fee Current I Y/N I <br />License # I I <br />Company I <br />Registered Y/N I Fee Current I Y/N I <br />License # I I <br />Company I <br />Registered Y/N I Fee CUrrent Y/N I <br />LicenSe # I I <br /> ""'" -~ <br /> <br />Rn out "pp1ia1tlon comp1etsIy. <br />Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br />If over $2500, a NotIce of Commellc;ement is required (Mechanical work over $5000) <br />Supply two (2) sets of drawings with apprlC8ble documentation <br />AllOW 10-14 days for revieW after submittal date. Parcel # - obtained from Property Tax NotIce (htIp:l/appraiser.pascogov.com) <br />