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1 62 C 1 <br /> b s.- .esv -wcu _ -- • - - - - 44 <br /> Pemlit <br /> Date Received <br /> - - Phone Donlectfos Pen* -052-3 Owners Name rom ,: i./ •. ` Orwefa Rhona Number . <br /> I <br /> Owners Address" - 1 _d/ ///. _. i '' ; z 1O /. i. I/ _ /C- / - 4 .1 /✓ - <br /> Fee Simple Tilleholder Name V A - rltehelderPlroee Member - I 11 11 <br /> Fee simpleilleholderAddress I / . <br /> 73 i . Let* 1 <br /> Job Address 2 _ �� _�/ !� �1_ e - ' - <br /> Sub Division L Parcel* <br /> E ,. Y ,._ . ' <br /> EJ Blad'ku®d *Ferro 9fono&- MeeAML CD Furriveion Teat <br /> E Comm Exhaust IGldtien Hootii0uct n lissedoes Wledet (tier R or RQ Fealty) ANNUAL <br /> n ContraNed f Q floodlneleieion <br /> ED Emergency Genewbr <30krr _ n i.Piliiiusal8we•iesisiaion <br /> F Emergency n Emergency Generator> 30 k IPll 6se.AlllluA _ Sale <br /> El Fee Proleri'ion WiMenerac -A/riiML - n Places of <br /> Sprinkler Li - o O o ri Remeelloeeel Hem <br /> Re Alarm 1 0 Sparklers <br /> Hood Clearing 13 D7 n I 1 Qteme indellations <br /> Hood Suppression 0 D 0 1- 1 Q ' ) <br /> El flee Alarm kwlell ion . J Tack Poolkagffsr Ka lle • <br /> ri !la Pin n Weals The Stoma NlfAUA- . <br /> Firs Works <br /> Flammable Appacelion-AIMMIAL <br /> 1 alP <br /> • Fuel Tats <br /> c - <br /> j t i <br /> Contractor d ;. r-+ ;' '�f`%�.f% 1 � a �' /�/ii/ <br /> swage ,./ 2Y >r ._sU ' e,_ Are _ "i 6!., R. Regildellet �.iLM Fee Carew& Y 1 N <br /> 1 Li oersrE 3 1 <br /> gP 1°x° 1 fie9frslewd I YIN ( Fes Current Y l N <br /> Address I ( tkarne if <br /> PLUMBER <br /> 0 <br /> Signature Regislewd # Y 1 N I Fee Currant j Y/ N, <br /> Address I 1 Limnos* I I <br /> MECHANICAL oor+a <br /> Signature RsgWewd Y 1 N I Fee Cu era I . YIN J <br /> Address I - 1 Limns* # ) I <br /> OTHER <br /> Signature Reviewed Y/ N _I Fee Ccnert 1 Y/ N f <br /> Address licenseik <br /> Directions: <br /> F# at applk ion eowerisleiy. <br /> Owner & Cantrxlersign back ceappidfon, misdeed (Or, copy of durst eoArect war owner) <br /> if over $2500. a Node. of Conenerxanwnt is sward adAlednnleal work over 05000) <br /> Supply lwo (2) sets of drawings Wel applicable doamenWlion <br /> Mow 10-14 days for review altar sobered dais. Parcel #- obtained lore Property Tar Nonce Q fi - Scrogov. ) <br />