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31?-7E�-O, Cil�/ Of Z ephyrhit�s f If8' rex-o � r� ov-vvc � . <br /> Permif Application — = <br /> D3f3 tZ ��eivsa" _ �j `31 ` ZQ � I - Phone Con,a:.^t for P=rmit $/ �p � �� <br /> :-r:s�.:k,�� --� _- --^"--�=--�-�---=^-�-a�c s.���.� � <br /> Own=rs �tame fJ v( � ( L L` �.. Owners Phons tJumber ��� C7 <br /> Owner's Address 11J j / 74 N�'`� 1J � CT 2/O <br /> �>e Simple TiU°holder Name Titishol�er Phone Number C] �� <br /> Fea SimpleTitleholdsrAddress <br /> � SSY�t�Y�9:�T! vy7y4,.kK6�/.�ia�FRi3—'�{{��"�Ity"P9L^fs�Ke �x�x,:yx'..tp��fi:.�.f.��' <br /> s�+y.`�ta�+��uif.a3xu+�*- ^��°-- ..e...��tyy,�'�5F'P�i~.��.lb" ����'� si. , -�.._... �w,' .�� '+�-� i7Y� X� <br /> Job Address C��e (,� Lot� � <br /> Sub Division Paroel# S`2S` �� �0• �� • ��� <br /> rw, - � - "' s- � - � asQ — s9�� a <br /> �.a�s�� � m <br /> � Bio-Hazard Waste Storage - ANNUAL � rumigation Tent <br /> � Co:nm Fxhaust Kitch=n Hood/Duct � Hazartious Mat>rial �er II or rZQ Faciliry) ANNUAL <br /> Q Con;roiled Sum � Hood instalia6on <br /> � Emergency G=nerator < 30 kw � LP/Natu21 Gas-tnstaliation <br /> � Emeraency Generator> 30 kw � LPlNatural Gas-ANNUAL Sale <br /> � Fira Protection Main!anance -ANNUAL � Places of Assembly-ANNUAt <br /> t y �erni �n nar <br /> Sprinkier � ❑ O � Recreatior�l Eum � �� (/"� <br /> Fire Alartn � ❑ ❑ ❑ � � Sparkl�rs .� <br /> Hood Cleaning � ❑ � O� a Sprinkler System Insialfations <br /> Hood Suppression � ❑ ❑ ❑ � � 5tandpipes (Sprinkler Sys) <br /> a Fre Alacm Instatlation � Torch Rooftnglfar Kettle <br /> � Fire Pumps � Waste Tira Storage ANNUAL <br /> Fte Works <br /> � Flammable Appfication- ANNUAL .(� Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> -,��.n� - - '-"„"�...:.� <br /> Contactor � � ��(.� Company <br /> Signature Registered N Fee Current Y <br /> Address Q Q-�/1 T L ( l ' License � /� <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License #? <br /> PLUMBER Company <br /> Signature Registared _ Y/ N Fee Cuaent l� / N <br /> Address License � <br /> MECHANICAL Company <br /> Signar�re Registered Y/ N Fes Current Y/ N <br /> Address License � <br /> oTHErZ Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License f <br /> - W..,.. ._ �_ - -�- <br /> :. _ - �_ :.�,_,_ .._. - ._ ..- � .:��....,- - ..._r._.� .��°�-_.�.`. _- _'--- --..,__..._.,a.:..a _�-� _�: <br /> Di, <br /> FII out applicafion completely. <br /> Owner $ C,on!ractor si�n back of application, no:ar'tzed (Or, copy of sianed contrect with owner) <br /> K over 52500, a Notice of Commencem=nt :s required (Mechanicai work over 550D0) <br /> Suaply two (2) s=_!s of dawi�gs with applicable documen;atian <br /> Allow 10-14 days for raviaw aftsr sJSmt�tal date. Para! ,°.- - ob,ain=d from ?ro�e ,ry Tax N�:i:e (h;;p:.,'ap�aiser,oasco�o�:corn) <br />