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<br /> _ Permit Application
<br /> Date Received �— Phone Contact for Psrmk _ .�� �'� :
<br /> . . ... „ :a._._: � , . . __.. _.. _�. t� ,. � ,� .,
<br /> Owner's Name FI e►' � o(ar s�+1 � o '{� r� -� -� Owners Phone Number `t�' ! �7 ,�2 y''-�' �
<br /> owners address ( ? D I i r 1`� o t;tr.t i�1 'r h i i( 5 i F L 3 3 5��-
<br /> Fee Simpie Tftleholder Name TiUeholder Phone Number ���
<br /> FeeSimple?iUehoiderAddross —
<br /> , �• . . . . ;:r;a, ^r;u , *,.
<br /> "�tA'E�k'! '�'?�t 3Yb'r:u+3;' �sdv"; i�K t4;_n:�+sr� * < 'w� q: �e. . . . . _ . ..
<br /> Job Address �7 o r�. �►- � o �, � h� � 1 s F"� 3 3��a- �t # �
<br /> Sub Division Pareel # bu�'�-` �(6 ��- O 0 I O-� 3�G� '"a0 (�O
<br /> . . .. ...v�...h.,r;.::;.•;.cv+,:::�Y: �sa� :r!�:x.�:sn;na�+a!�s'rr�a,=z��+r=�: .., . . ,. , ,
<br /> .•, . <�R.t.•w . ?t'vL' ..: �E;'.. .w+h. �,r�„�
<br /> � .. _ .... : x,ii+.o-
<br /> Bio-Hazard Waste Storage - ANNUAL �� Fumigatlon TeM
<br /> 0 �m �� ��n ��� a Hazarda�s Material (Tier il or RQ Facility) ANNUAL
<br /> o ����e�, o �����e��
<br /> � Emergency Generator < 3p kwr a LP/Natural Gas-tnstallatlon
<br /> Emergency Generator> 30 kw � LP/Natural Gas-ANNUAL Sals
<br /> � � �' ��^�� �N�� � Places of Assembly-ANNUAL
<br /> �� � �� � � j 5 ��
<br /> Sprinkler 14( ❑ ❑ Recreational Bum �
<br /> Fire Alartn � ❑ ❑ O �� � Sparklers
<br /> F�ood Cleaning � O O ❑�� a Sprinkler System Installations
<br /> Hood Suppression �❑ p D�� � Standpipes (Sprinkler Sys)
<br /> a Fire Alartn InstallaUon � Tor�ch RooflnglTar Kettle
<br /> Fire Pumps � Waste Tire Storage ANNUAL
<br /> Fre Works
<br /> Flammeble ApplicaUon- ANNUAL 1 o0
<br /> l l(n5 � Valuation of Project
<br /> Fuel Tanks
<br /> [� Other.
<br /> � ' . _ <.. '4i?�:�i?:,;xSr.. . .<r.w's;imoae.�"�..'xi+�x�...5.�-:etdmi°R�33C.i�'w`+h':��'dttA".'.'a'�Z.izn.L")."§:i•:«<'It'k':•�.^�'::'rr.�.•;3�tta"���:4:i .Sii.Pli;"Ji'S.,r<'+a :........ .... .a,'
<br /> C.OII�'BCtOf � .3'�kY�r.��� '::+! x,r ,±Yc�.:'V`c: ..;t�•��.'y, <��se..�,
<br /> �� , C.OM
<br /> Signature 1-�1/` Regi � Y/ N Fee Current Y/ N
<br /> nddress '7�1 t�' �ss fa.c�, ar� L 3363 7 ucenae #
<br /> ELECTRICWN ��
<br /> Signature � .
<br /> Registerod Y/ N Fee cument Y/ N
<br /> Addross lJcense #
<br /> PLUMBER ��
<br /> Signature
<br /> Registered Y/ N Fee Cumerrt Y/ N
<br /> Addross License #
<br /> MEChWNI ��
<br /> Signawre t�egiatarod Y/ N Fee Currern Y/ N
<br /> � Ucense #
<br /> OTHER
<br /> Cort►Pe�Y
<br /> signature Regtsterod Y/ N r-ee Cumerrt Y/ N
<br /> Directlons ..,,_ - a ..,.. ,> ..._.... ,.� _ .:,.� .:.�a,, ....,�:., a , +;�... _ , ,. .. ,., .��:�,.._. , . �•a:aa�s ��#- . :..�,. .� ,,,:�.,... �.... �, w .. . � ...� , . s:�sa•r
<br /> Fiil out appilcatlon completely.
<br /> Owner & Contractor sign back of applicatlon, notarized (Or, coPY of signed comract with owner)
<br /> K ower 51500, a Notke of Comrt�encement fs requirsd (Msehanical woric over 55000)
<br /> S�+PP�Y �(2) seffi aF drawfngs wfth appiicable doeumsrKation
<br /> Allow 1 Q14 days for roview aRer submittal date. Pareet #- obtained irom Property Tax Notice (httpJ/appralser.pascwgov.com)
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