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313-780-0020 C(�/ Of ZBPIIyfI'IIIIS F I�°� rax-o i o-r ov-vv� i <br /> � Permit Application — - <br /> D=ts R°ceived � '?j� ' �i�� � �,���,,,� Phone ContactforPertnk / �OZi ( � S +u <br /> n,�- -� : ._ ...,..r ,.....�.... „�:�..,:.-.,u .. <br /> ' Own=rs Name � � A � G L r ivlc.� Owners Phons Number �� � FSO g� <br /> OwnersAddnss FS� '��' Ar�C- Q�� � 5 L 35 <br /> ==e Simple Titleholder Name Titl<holder Phon< Number ���� <br /> Fee SimpleTitlsholderAddrsss � <br /> �"� - �rx��� .si.E..�.' a°�s �'..-...,«��".�".a.. '"�„''�.�-�°°....:�.� -� r_?.sa �` :,�5;,��.,.s.rri , <br /> Job Address g � � � p� Lot� C� <br /> Sub Division Parce! # �Z ` Z 6`Z �' ��� �- � q�' � <br /> .�.a�z �: <br /> [�i.k - � � .. <br /> � BiaY,azard Waste Storege -ANNUAL � Fumigation Tent , <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material �er II or RQ Facility) A iIAL <br /> � Controtled 8um � Hood Installation <br /> � Em>rgency Generator < 30 kw � LPINatural Gas-Installation �I <br /> � Emeraency Generator> 30 kw � LP/tdatural Gas-ANNUAL Sale ���� <br /> � Firs Protection Maintenance - ANNt1AL � Places of Assembly-ANNUAL <br /> tr y emi Qn er <br /> Spri�kler � ❑ p � Recreational Sum <br /> Fire Alartn � ❑ ❑ i7 � � Sparkl>rs - <br /> Hood Cleaning � O ❑ O� a Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> � Fre Alarm Installation � Torch RoofingfTar Kettle <br /> � Fire Pumps � Waste Tire Storega ANNUAL <br /> Fire Works <br /> � Ftammable Appfication-ANNUAL .�� Valuation of Project <br /> Fuei Tanks <br /> Q Other: <br /> ConVactor '�' f� ��(� Company N <br /> Signature . d Registered f� Fee Currertt N <br /> Address / . '7 ( License # id 0 ! `� <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> PLUM9ER Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License � <br /> MECHANICAL Company <br /> Signature Registered l� / N Fee Curtent l� / n1 <br /> Address License # <br /> OTH_R Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License r <br /> ��•�^ - - - Ld-i.....�-- _ - ..,.�_.�.. _y�-� .� ,,,._�:��: <br /> Direcfio�s: <br /> Ffl out application completely. <br /> Ownsr & ConVactor si�n back of application, no:arized (Or, copy of signe� conirect with owner) <br /> If ov=r 52500, a Notice of Commencem=nt is required (Mechanical work over 55000) <br /> Supply two (2) s=ts of drewings with applicable documen;ation <br /> Allow 10-14 days for review aft=r submittal date. Parcel r- obtained from Property Tax Nctice (http:/la�p;aiser.pas�o�ov.com) <br />