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a,s Permit,,, <br /> te Received -- Phone Contact Permit <br /> were learns MK •r. Owner's Phone Number <br /> IDIMII ffil 1 as <br /> wieesAddFess 1 b.1D 3& clAoci 1 11 H I <br /> e Simple 110ehoider Noma 1 I Titleholder Phone Nundsar b Simplelblehoidar Address d ` ie. . � sue. a z x _ _ _. � .. . = a - r_ c_ <br /> I • <br /> ,,',Jr- Y'-r _�.. ------,- <br /> - s.i'S. �a^�G 'iisi�w .. ... _ . .>F' Lot* Parcel di <br /> rb ub n 1G. _ i 1+. <br /> Q Fumigation Tent <br /> El Sio-liazard <br /> Exhaust Warms -- I-1 , us r Crier it or an Feoatr) ear - <br /> Q �, r + tloadiDk>et <br /> El Controled Burn . n Mod kestalalicat <br /> Q Emergency o t <br /> B e snessbr> 30 kw <br /> Emergency Plazas ofAasently- A/IUAL <br /> Re Protection - ® Egg LI L'.II <br /> Spdirkkor Q ❑ ❑ El Ftecreational Burn <br /> Fke Mann Q ❑ ❑ ❑ 1 1 Sparklers <br /> Hood Cleaning NO <br /> S System t Suppression a <br /> Hood 13 13 1 1 a Ste,dpipes(Spri,kferSYs) <br /> rod Alannintilallelibn Q T«ehFaoosnerr &xa� <br /> Fee Works <br /> Fiersnable ED Waste Tire Stomps ANNUAL- <br /> Application- ANNUAL ' 1 Valuation of Project <br /> Pu.1Tenks company 1 <br /> III Other 1 <br /> Cam <br /> Nt <br /> , • Z . > , Via Y 1 N 1 Fes aara+E I Y! N <br /> Address allar ts-4AP IIIIrtl y - license* 1 <br /> - ` Registered , Y 1 N 1 Fee Current 1 Y'1 N f <br /> Company <br /> tom# 1 <br /> Address 1 Registered I Y/ N I Fes Qarent ) Y/ N( I <br /> ( License# 1 <br /> Ate( 1 <br /> TwirMEC=Cil I Registered l Y/ N ' Fee Current 1 Y/ N <br /> Addis= 1 ( <br /> MAR I Registered L Y/ N 1 Fee Cuffed I Y I N 1 <br /> Signature 1 Adams <br /> Dinactionrc F1/ out appticaior+completely. <br /> Grater & Contractor align beak of application, notarrasd (or, copy of signed correct with owned <br /> If over 121500. a Notice of Ookmksnoamwt is requt ed 4(Yecrakrid work over $5000) <br /> Supply two (2) sets of draeings set applicable document°aO1 t� #- obtained from Property lax Nance (t pD ) <br /> Alm 10-14 days for review after submittal date. <br />