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X 0`9 3 <br /> d 1sisv -wcu - <br /> . Permit AppliicaBori <br /> QlarieCorMetttosParnelt _. <br /> Date Received . <br /> i Oaiwet"a Phone Number ���� LL" -J COL <br /> Owners Name I Oaf, Pei <br /> Address' 1 5a 7 6»/J /21'D <br /> Fee Sknpie Titleholder' Nana I iti Taebalder Phone Number I I I 1 <br /> Fee Sirtple llddi 1 ✓' ` <br /> 7 <br /> .dab Address 1 .5 A VD 71 4011'.` M 339/0 * 1 <br /> Q Weeks - ED fweig dfen Tent <br /> ED Conn Exhaust Kitchen Hoodit)rrct ED Nowadays Malarial flier ! arRi3 Farlhr) ANNtfAL <br /> 0 Conkolled Bum . Q hood kaieieaoa <br /> Esessrancy Generator < 36 ion r t Ptaatnart Gas-b etedaNan <br /> weog.,ncy Generator> 30 kw r LPI esmat eeerANNUAt side <br /> R Fie Peoiec un Mai ienance- ANllt1AL - 1=3 Places df PasearmhlyANNUAL <br /> Sprei.ler � .a 0 Q 79 ri Recrusliored Bum <br /> Fire Nerm !' 1 / 0 I 0 O 1 I Q Spedime <br /> Hood N 11 i ❑ D Q ''�� <br /> Hood Suppeesaion El 0 D a j' _! Ss) <br /> El Fine Me m kadallaion y Tomb R°O Kallko <br /> Fire t ! e Pumps Weide lire Stomas AINNUAL <br /> Fine <br /> Flammable App 1 1 of Project <br /> ioefOn. -AtO W4L <br /> Fuel Tanks _ <br /> Contractor I ,9 i ww <br /> Signature I Re stwe+1. 1 Y 1 N - 1 Fee Gwent I Y N 1 <br /> Aaldrees r7Aira.,/I7.?/�",A iii2n�7 }� irk ®� LiCOn•e* I <br /> ELECTR I,)C/ Comma /���� j� /0 / Fl elialeeer! J N Fee Mornay , Y 1 N <br /> Signature Address i, ;/ ' License* I I Company <br /> seams firglskeed I ¥!'4 1 Fee Cement f Y/ N <br /> Address ( License* I I <br /> MECHANICAL <br /> I Company <br /> Signature Registered Y / N , Fee Grandy [ Y / N <br /> Address ! - 1 Boon.. fr - 1 I <br /> OTHER <br /> Signature 1 Flegieeerrd I Y 1 N r Fee curium j Y / N I <br /> Address License* <br /> Directions: <br /> F# out application complataty. <br /> Owner & Coneraclor sign back of appiiesiort, noteelned (0r; maw of signed connect wiew owner) <br /> If over 52500. a No0ce of Commencement is regwird.(Mechanieal work over MOO) <br /> Supply two (2) sate of Mowing/swab applicable documentation <br /> Allow 10-14 clays for review alter nutmeat data. Parted le- cbilined fora Pox/party Tart Node* (idrpotappraiser paseogov.com) <br />