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313 % 0 �'il�/ OT Z. ephyrhius Fir rax-o � o-r ov-w� i <br /> Permit Application — - <br /> Dats Receiv�d - Phone Con;act for Psrtnit 81'J LZ� �°Sj7 <br /> £i?':$��°+�IiL.T"'r.�i?�.era�l.es,���.s_�.r:....x. 3"M .- �E��'^'�S!�S$S`¢""`�islaR'.i3['t7.`L �T�•:3r-Cr.L °�"3�Ta...uY.. �a+..iY.v :,I.a�-i. .�-.« �.a-..: <br /> �, _'_ <br /> Own=r's t�am� r�(.(�Zi� (�1C�e— L-`1.�n�C. Owners Phone tJumber �� � <br /> Owner`s Address 3�S �U1 /m�R..kC.''� V�LZ.C+ 7� 4�..��}l(1.b 3 3�Z <br /> Fee Simple TiUeholder Name Titlshold=r Phone Number �� ��] <br /> Fee SimpieTitlshoiderAddrsss <br /> r-�r„�F.�� Gaa.. - --- �eA�,s�.,�r•.,E�a,�.�'ux"�f�`'.��v'a�s��'k,���w??�3v�''�'..��3...."�"'E�". �;�;:F;='...�xras�n::.._<..k+°'�.+=`�"`,�;.:3:x; <br /> JobAddress ?3 C)'� l�'Q-YC.� S (J�'dLL �2. (L1-;'IL(rS �'r(, Lot� �� <br /> Sub Division L. � 1`� � Parcel # <br /> � ��� <br /> � Bio-Hazard Waste Storege - ANNUAL � Fumigation Tent <br /> a Comm Exhaust #Citchen Hood/Duct � Hazartious Material (Tier Il or RQ Facility) AHNUAL <br /> Q Controiled Bum a Hood Installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Installation <br /> � Emerae�cy Generator> 30 kw a LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance -ANNUAL � Places of Assembly-ANNUAL � <br /> tr y emi �n nar J K � <br /> Sprinkier �'J p ❑ � � Recreationai 0um I�' ✓ <br /> Fire Alarm � ❑ O ❑ � � Sparkl=rs <br /> �` <br /> Hood Cleaning � � ❑ ❑ � � SprinklerSystem (nstallations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Instailation a Torch Roofinglfar Kettle <br /> Fire Pumps � Waste Ttre Storaga ANNUAL <br /> Fire Works <br /> Flammable Application-ANNUAL �S'� Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> .� . - T =--,� <br /> ConUactor Company <br /> Signature Regist�red Y/ N Fee Cutrent Y/� <br /> Address License � <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> PLUMBER Company <br /> Signature . Registered Y/ N Fee Current Y/ N <br /> Address License � <br /> MECHANICAL Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> OTH�R "�:.�L2�1 '(Z Company �pZjar� �IIZ�G. �rZ.�A1,K1.k�S I�� <br /> Signature Registered Fea Current � N <br /> Address � . , � . '� License � <br /> ,; _ _ ..,_ _.a._�_ _ <br /> �o � ?�C7GY� � �' <br /> " �-t-- --,.. - '�s'""'.�"'m' .�.,�,..._�......... ,._..� ..t....... -""'z..._l==i��.y: <br /> - - - _-�.-�. - ..........�_.-. ...i _�.. _ _ w..� _.__ <br /> �Dire�tior,s: <br /> Fiil out applicafion completely. <br /> Owner 8 Con;ractor sign back of aoplication, no;artzed (Or, copy of signed contract with owner) <br /> If ovsr 52500, a Notice of Commencement is required {Mechanical work over 55000) <br /> Suooly two (2) s=ts of drewings with applicabie documen;ation <br /> Allow 10-14 days for review aft=r submi;taf date. Parei r- obtained from Property Tax No;i�e (http�/a��aiser.oascogov.com) <br />