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3�3-780-OG20 ('.Iry Of z°pf1Y�r11IIS Fii v�• rax-o io-r ov-w� i <br /> ' P�rmit Appiication _ _. <br /> D3t9 R°C eived �S • 3(' 20 �( - Phone Con,act ior Pertnit �a� Z( 3 7 <br /> ;��s��-��'a�°°� .:. :.,...:..:...W.�<:�c,�N°st�.���:�.-�-�,..az� ��� x ..,..r,......._.,,-�...,..-...,n-..��._ _,. <br /> Own=r's Name � �L, GL //V ( C.. Owners Phons Number ��� C] <br /> Owners Address $� 0 I �iT TtR'L �l 11� �� i� <br /> res Simple TiUeholder Nams Titleholder Phons Number �� � <br /> Fee SimpleTitleholdsrAddress <br /> rv- a.; P - �' �"��";,�s <.x'5.�:`.Y�'^ ;.�,�;�^_:-��r•��c�r� <br /> JobAddress 0 S � Lot# �� <br /> Sub Division Paroel # <br /> �,.k � - . r�^� �--- �=-�� <br /> � Bio-Hazard Waste Storege-ANNUAL � FumigationTent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material ('fier II or RQ Faciliry) ANNUAL <br /> � Controtied Bum a Hood InstallaGon <br /> a Em=rgency Generator < 30 kw � LP/Natutal Gas-Installatio , <br /> � Emergency Generetor> 30 kw � LP/Natural Gas-ANNUA Sale �'(q � <br /> � Fre Protection Maintenance - ANNUAL � Piaces of Assembly-AN L <br /> t y emi Q ar - <br /> Spnnkler � ❑ ❑ � Recreational Bum <br /> �ire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cfeaning � O ❑ ❑� � Sprinkler System Instalfations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alarm ]nstallation � Torch RoofinglTar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> Fire Works <br /> � Flammab(e Application- ANNUAL . �� Valuation of Project <br /> Fuel Tanks <br /> Q Other. <br /> ConUactor ,���j/ '� ���j� Company <br /> Signature ^� � Ragistered Y N Fee Current Y N <br /> Address �'j�Q � • '�Q License � OO � � � � <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 ree Current Y/ N <br /> Address License # <br /> OTHER Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License r <br /> �t x,.a ._ ._...... ..� .�'�'---=�,.s- ..; . .. . . . �w:��k..�,�..:,.,.,,...,w ---:_.._.._._ _ _...__..�.�.y -= rrr�-_�.:it�:�ii: <br /> Directians: <br /> Fill out application completely. <br /> Owner & Contactor sign back of aoplication, no:arized (Or, copy of sign�d contrect with ownsr) <br /> If ov=r 5250�, a Notice of Commen�>m=nt Is required (Mechanical work over 55000) <br /> Supnly two (2) sets of drewings with appli:zb(e doeumentation <br /> Allow �D-14 days for revi=w aft=r su5mi;tat date. Paro=1 r- obtained from Property Tax Notice (http://a���aiser.o=_scogov.co�n) <br />