Laserfiche WebLink
393-780-0020 �i�� Of Z ephyrhifls F[c �' ren-o tri ov-wt i <br /> Permit Application — - <br /> Dats Received .'� ' 3 � ' Z� � � � Phone Con;act for Pertnit s � I ? j (p2 � / �js � <br /> :�:��:F .�.a..a��; �a..-.. ...�......,,...,., _ _,.�....�.�^ � _ . >..::.,......:.«:..,: <br /> Own_r's Name �/J V�� W � l. C. Owners Phone Number g� 7�� 3 7 S7 T <br /> Own=r's Addrsss 7 Z s�S'�"�0��.�+i.N � t� J,�t,� 2� oL <br /> F=e Simple Titleholder Name Titlaholder Phons Number �� �� � <br /> Fee SimpleTitiehold�rAddress <br /> �_. . r,c,.� �irf,�t::?"s,.�'� ��cea�-,�-r��.;r _ �'� <br /> 1.���..�` <br /> Job Address � Y� ��'+u. �.V�J Lot � <br /> Sub Division Paroel # S' S" '�) 0• �$'v � <br /> �s�. < <br /> � Bio-tiazard Waste 5torege - ANNUAL a Fumigation Tent <br /> a Comm Exhaust Kitchen Hood/Duct � Hazartious Materiai �>r II or RQ Facility) ANNUAL <br /> � Controiled Bum � Hood Installation <br /> � Emergency Generator < 30 kw a LPlNatural Gas-Installation <br /> a Emeraency Generator> 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance -ANNUAL a Places of Assembly-ANNUAL <br /> tny emi �n her / (a, �?,- <br /> Sprinkler � ❑ ❑ � � Recreational8um � I / l <br /> Fire Alarm � ❑ O ❑ � � Sparkters <br /> � l <br /> Hood Cleaning � ❑ ❑ O� � Sprinkler System instaffations <br /> Hood Suppression � ❑ � O� � Standpipes (Sprinkler Sys) <br /> � Fre Alarm Instailation � 7orch RoofinglTar Kettle <br /> Fire Pumps � Waste Tire Storage ANNUAL <br /> Fre Works <br /> Flammable Application- ANNUAL ' s. Qv Valuatian of Project <br /> Fuel Tanks <br /> Q Other: <br /> Contractor "r, �0� Company <br /> Signature Registered / N Fee Current l� / <br /> Address v/ l 1f . O s License # 1 <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> PLUMBER Company <br /> Signature Registered Y/ N Fea Current Y! N <br /> Address License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> OTH�F2 ^Y <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> v�,.::_, �< ,v <br /> x..x� - - -- -.,.....=��F - - ,u...:ss.. ...¢..�.... —<.�� ��v.T-.. --�ss.--`--�--'°"�- y- . <br /> �'Directiors: <br /> Fill out appiicafion completely. <br /> Owner & Con!ractor sign back of anp(ication, notar,'zed {Or, copy of si�ned contrect with owner) <br /> tf over 5250d, a Notice of Comm=nc<_ment is required (Mechanical work over 55000) <br /> Suoply two (2) s=;s of drawings with appficzble documentation <br /> Aflow 10-'14 days for review aft>r submi:tal date. Parcel ,= - obtained from Property Tax No,ice (http:/lap�aiser.oas�ogov.com) <br />