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313-7&0-0020 (',l�/ Of Z F'IF-v�' rax-o i rr ov-�v_ � <br /> � � Permit Appiica`.ion _ . _. <br /> Date Recefved 5— �' � �� Phone Con;act for Pertnit $`� (� Z� /� � <br /> ��:^ �...<_....�.�.� :......>-.,:....�v . . _�����3 -.� .X,_�.�ss _�y...�.� .,.�w.�..ar,_ . . ._- ._ .., <br /> Own_r's Nams !x�l�,� ��.W (L �,�► Owner's Phone Number � Q (O �O� �� <br /> Owners Address �i0it1 S�/ O 0(.keElJ sT/4'� �..h► IJ l,J �.i � 90O / 0 Z <br /> F>e Simple Titleholder Nams Titleholder Phone Humber �� <br /> Fee SimpleTitieholderAddress <br /> ��a�csrsxae- :� �' �...�.�.�sK��°-+f� _ �. �'�'?-�`�..�°�°^'�'s:E�:�3a.*.:ik - <br /> JobAddress � �,, V lot� C] <br /> Sub Division Parcel # � 3S'25 `Z �' ��0 • D�at� ` 0�� <br /> �xt ,.-^�..�..,°.�,�.,��. <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlfed Bum � tiood instaltation <br /> a �mergency Generator < 30 kw a LPlNaturat Gas-Installation <br /> � Emeraency Generator> 30 kw a LPINatural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL r <br /> � try emi Qn ar a J �� r <br /> Sprinkler ❑ ❑ Recreationai 8um � / <br /> Fire Alarm � O ❑ O� � Sparklers <br /> 6' ` <br /> Hood Cleaning � O ❑ ❑� a 5prinkler System Instalfations <br /> Hood Suppression � p ❑ D� a Standpipas (Sprinkler Sys) <br /> � Fire Alartn Installation a Torch RoofinglTar Kettle <br /> � Fire Pumps � Waste Tire Storege ANNUAL <br /> Fire Works <br /> � Flammable Application- ANNUAL .��� Valuation of Project <br /> Fuel Tanks <br /> Q Other. <br /> - ..�� <br /> Confractor '� �-'�"� Company �. <br /> Signature Registered Y N Fee Current Y N � <br /> Address Q � License # Q( <br /> ELECTRlClAN 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 /> MECHANlCAL Company <br /> Signature Registe2d Y/ N ree Current Y/ N <br /> Address License � <br /> OTHER Company <br /> Signatura Registered Y/ N Fee Current Y/ N <br /> Address � License � <br /> �'Di; ections: <br /> -- �^- °------ •.��.. - -- - - -- - .,- - - ...._._..... .. - _.r..,_�..,..- - - - -- ..r..........e:�..a.�,_� _�„--_�:,�:�; <br /> FII out app(ication compietely. <br /> Owner & Con:ractor sign back of application, no;arized (Or, copy of signed contrect with owner) <br /> tf ov�r 52500, a Notice of Commencement is required (Mechanical work over 55000) <br /> Suoply two (2) sets of drawinas with appiioable documen,ation <br /> Ailow 10-14 days for review aftsr submittal date. Pares� :- - obt3ined from Property Tax No;ice (nttpl'ap�2iser.pasoogov.com) <br />