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<br /> _ (.;ity or zepnymine Fire
<br /> Permit Application dr 13 F _ • • 13-780-0021
<br /> Dete Reoeiveg
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<br /> Phone Con - • Pernik MUNI EMI KUM
<br /> , o , x: , : ,, ivrr•iiir.loynqin.., .., OV.,,, .f1,0/031701...1 ' L..i4L—Trm%.". 7....
<br /> Owner's Name 2' lk (5-(7.pplivrh,11 . . "(
<br /> 7eLyj s- Owner's Phan _ umber 1 'P k / 31 4 4..,4 - 1 S ZD.51
<br /> Owners Address 1 621s / II Rad- '1,T)A. • - Oa) Zez c, I'? ,..? S" R. I
<br /> Fee Simple Titleholder Name // Titleholder Ph• = Number 1 r[ - 3 11 ig 1 2,g-es1
<br /> Fee Simple Titleholder Address r,:,FlrgallrAnre:„ZrrtltjPi tillararif
<br /> Job Address 6 t. r 4? APEZWIREMEMICii • ..,/..c J #
<br /> Sub Division 1 Parcel $ r..)- t -00 La -; -, o0 00
<br /> :,- . , , , _ , .., ,. • • , .. ,, ,. • ., •• •.• 0 " •• .. I ...., , r-).;. , ,r7-,....7 ,
<br /> El Bio-Halird Wa • Storage - ANNUAL El Fumipation T - •
<br /> 7 Comm i.xtleust &hen Hood/Duct 1=1 Hazardous Ma! 'al (Tier 0 pr RC' FaCility) ANN
<br /> 7 Controlld Bum • E:1 Hood Install -- J.1
<br /> ,
<br /> 0 Emergecy G ' r < 30 kw = LP/Natural 0
<br /> 7 EmergeImy Gentiator , 30 kw El LP/Natural G- NNUAL Sale
<br /> I liel Fire Protection Intenance • ANNUAL = maces of Anti • ly-ANNUAL
<br /> 1 .-- 1 MI E=i IM 221 . .
<br /> Sprinklir Li 0 . 0 0 = Recreational B
<br /> Fire Alain I:=1 0 0 0 1 ------ 1 L] Spenders ! I
<br /> Hood Cisaning 0 0 i I 1 ri Sprinkler Sy ._..- Installations
<br /> Hood Sippressh LJ b of 0 1 1
<br /> 1 Li Standpipes (S. kier Sys) I
<br /> 1 ,
<br /> =
<br /> Fire Ala Install/lion Torch Rodin! • r Kettle ,.
<br /> = Fire Pu ps f Waste Tire S■• • a ANNUAL
<br /> = Fire Wake •
<br /> 1'
<br /> fl] Flammal)le Aeon on- ANNUAL I 4 niill Valuation of P i '-ject
<br /> = Fuel Ta ks
<br /> ill
<br /> ri Other: 1 11
<br /> fr i
<br /> 1 __
<br /> !Ilin1.703101E.SMIM175"MariNVTIREET.: %.71;312111111rearDIFSPErnerrairAMMORMEMICIMOSSMEM _J
<br /> IZ ' ^, - • ' . ' ' ' ••• ' - '' ' ' ' ' ' ' -' , L ' . .- , • • • . ■ '
<br /> Contractor / , - 111C-
<br /> Signature k•e..■-•••--- (4...../ Registered ir J17. Fee Current rzcs
<br /> ...
<br /> Address A .jge, 1 1W 7 ■74 - "LialgolY1:7171EINEECOgaitfr - ' ucense * I:. • ..rrya.0 (90/ A.e7 1 i
<br /> ELECTRICIAN Company I 1
<br /> Signature I Registered ' / N 1 Fee Current 1 IV 1 N 1
<br /> Address 1
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<br /> I License*/ •
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<br /> i _
<br /> PLUMBER Co _I
<br /> ,.:-
<br /> Company Signature 1
<br /> Signature Registered • / N 1 Fee Current / N
<br /> Address I 1 License # !
<br /> MECHANICA Company I
<br /> Sign . ature I Registered /N 1 Fee Current 1 FiN I
<br /> Address f License* J i I
<br /> 011 CR
<br /> Company •
<br /> . ,
<br /> Signature Registered 1 zir i=miLt3rE. .
<br /> Address 1 1 Licensn* •
<br /> :;0vir.:1:111erNarratai‘,..imomi...e.,11...nwrr: vifelhANolk . ' 4.1.......... .^. ,,' s • 1 '. ' r .... ....r , , %. .. . 1
<br /> Directions:
<br /> Fill out applicatf comp! ly. •
<br /> Owner S. Contra r sign of oppllootlen, notarized (Or, Dopy of signed contract virth awner) •
<br /> if over $2500, a 1 tree Of mmencement is required (Mechanical work over $5000)
<br /> Supply ONO (2) s of d with applicable documentation
<br /> Ailow 10.14 dy Dr revict after submittal date. Parcel* obtained from 'petty Tex ........ • ;oe (http://appraiser,p .1111 m)
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