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813 - 780.0020 City ofZephyrtiNs FMB- * e y/ 2 Fw- 813- 78O.0021 <br /> - Permit App&ciun <br /> Dale Received <br /> �: 1 Phone Permit <br /> Owner's Nara r ..1. t > Owner's Phone Minter J b " I ( 7X <br /> Owns'sAddress 1 X 79. 'T o r f-- > z A T! ei <br /> fbe Sinpis'Tieirdda' Herne 1 1 Ttidaoid.FPhorre Number <br /> 1 11 11 <br /> Fee Ss llisholder Address ) <br /> ... _au.�„ �.a. -. - . era.. V • .. r. �:±r' _ <br /> Job Address <br /> Lct# 1 <br /> Sub Division Parma# <br /> E Waste 0-p -ANNUAL Tant <br /> El Carpe Eideuet lichen Hood/Duet "k0- Qr t^-. 0 Hazardous MANN (Tier D orR(2 Facr)ANNUAL <br /> Q Controlled Bum 1D Hood lnahiatton <br /> Emergency x <30 lav 1l LIHNsluialeseui sieieion <br /> Emerge cyOwveraiora 30 kw LP1lttebaet Br/t1/NAAL Sate <br /> Rep Prolsciionktekienenoe-ANNUAL - 1....! F cs, Aiessi ly#14iX1AL ISM RES EMI <br /> r ■ 0 0 0 riir 1 <br /> Rue Akron ® 0 0 0 �s <br /> Hood Cleaning ® a 0 0 I Spirdder Spawn <br /> Hood Suspresd0n E 0 0 0 , Q Standpipes POWs-Sr) <br /> Fes Alums krelaiaion Torch Roainpfiar Kates <br /> :' <br /> Pee Pumps Waste The Storage ANN ANNUAL <br /> Flees I cdo <br /> Fie n neble Appieaia n-AIN UM- I 1 Voltage!' ofPrejec t <br /> Rol Tanks <br /> Q Mar. I <br /> Signature I I Registered I Y/ N 1 Re current I Y/ N t <br /> Address I 1 - Manse* . I 1 <br /> Registered I Y/ N j Fee Came 1 Y/N <br /> Address I 1 License* I 1 <br /> PLUMMER <br /> I Onspery <br /> Signature . I Regained l Y/ N 1 Fie Current 1 Y/N 1 <br /> Address I <br /> 1 License* I • 1 <br /> MECHANICA9 <br /> 1 Cowpony <br /> Registered ¥ / NI Fes Curet f Y/ P1 <br /> Address I 1 License* I 1 <br /> OTHER CedoPHY S A. .+a E L. <br /> si gnature I -,-- e....„5...40,64...-z...... RsgiMarsd CS��` Fee Curet Y/ N <br /> Add/ ells 11! e� 75 } NI it i''� ,.FA I I PWIPM11111111111 License* <br /> Furl out appioaion awaadetely. <br /> Owner & Contactor star beak et application. nolaAaad (Or, copy of signed contract *Oh owner) <br /> If over 52600. a <br /> P. of Gomnenosn.nt is regnsed.(lreehn.ied work over $5000) <br /> Supply two (2) astir of dwwings rrtia applicable documentation <br /> Mow 10-14 days for review aifer submits' dote. Parcel #- obtained tom Roparly Tax N. ( Aappraiaar pa000gov oom) <br />