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31°-7£D-0^=. ('il�f OfZ �phyrhilis FI!' rax-oi�-rov-vvci <br /> Permit Application --. _ _ <br /> Date rZeceiv=d � Phone Con;act ior Pertnit (� GZ � 3$�1 <br /> : r�:��:. v .�---<rr.��,: - ..;�.--.;.<_�....�x;.�,..'.UZ,x:.....>..�.e..� .��.�����*��ss�� - - �f,._._.,_ --�_.-°--_�_ <br /> ! <br /> Owner's Name �l J Cl.t7 C. LLG Ownels Phone Number 4 �� �� <br /> Owne�s Address �7i'S �'t� �'�'77�K-(.sN S 2� (3(kC.A- U� +a`f7� �F L 1 U z <br /> r=e Simple 7itieholder Nams Titleholde� Phone Number ��� � <br /> Fee SimplaTitlsfiolder Address <br /> !�`�3� ""��'"' . s .���,+c.a�..r�"'- .. - . � - _ � w� ' «h?�.`°.:":':�5�. `-i"i`�_'..""�.� —a� 'cx'zc'°a�st ,. - r K :��� •-_ . <br /> . sn ' - a4 � �='?�_� : <br /> Job Address �j�U (y�,L �C.�1� zG..�14'`(2)�'fiC-L-°� lot� �� <br /> 5ub Division Paroel � S• Z � O � O <br /> ,fi -� r�2r <br /> a Bio-tiazard Wast= Storege -ANNUAL � Fumigation Tent <br /> a Comm Exhaust Kitchen HoodlDuct � Hazardous Materia( (Tier II or RQ Faciliry) ANNUAL <br /> a Controiled Bum � Hood lnstallation <br /> � Emergency Generator < 30 kw a LPlNaturai Gas-Installation <br /> � Emergency Generetor> 30 kw � LP/Naturel Gas-ANNUAl. Sale <br /> � Fira Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> tr y emi Qn ar ����(� <br /> Sprinkier (� ❑ ❑ � � Recreatiortal Bum ,� <br /> Fire Atarm ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ � ❑� � Sprinkler Sysiem Instalfations <br /> Hood Suppression � ❑ ❑ O� � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Instailation � Tor�h Roofingffar Kettle <br /> Fire Pumps � Waste Tire Sforaga ANNUAL <br /> Fire Works <br /> FlammableApplication-ANNUAL Z� Vafuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> .� - -;:� <br /> Contrector Company <br /> Signature Regfstered Y/ N Fee Current Y/ N <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 Licertse # <br /> MECHANICAL Company <br /> Signature Registered Y! N Fee Current Y/ N <br /> Address License # <br /> OTH�R ,�2.(LY 'T: Company 1A2C.. <br /> Signature Registered I�l Fee Current �j/ N <br /> Address ��, p ( License � �} $ C9O � 1 � <br /> . . <br /> � ..,<_ _.._. -- .-:_=.�..-�...� -- �' - __.,,�...>� - - - - —,..�...�...�w_..,...s.�,�... u����. <br /> .,� ...::....... .�. . . v�,=�.�_.:_.__:�...�...._.� .�_. ._ �.�,..< •: <br /> Directior,s: � � <br /> Ffl out application completely. <br /> Owner & Con:2ctor sign back of application, no:ar'tzed (Or, copy of signed contrect with owner) <br /> ff ovsr 52500, a Nofice of Commsncement fs required {Mechanicaf work over 55000) <br /> Supply fivo (2) s=ts of drawings with appficabie documen;ation <br /> Allow 10-14 days for review aft=r submittai date. Paroe! ,=- obtained from Property Tax No,i:.e (htto:/lap�;aiser.pascogov.com) <br />