Laserfiche WebLink
�13-7°�-n^2� (��� C,f 7c p�y r .r11�!j f I"� rev-o i o-� ov-vvc i <br /> Permit Appfication ___ __ <br /> Date Received ' �" - Phone ContactforPertnit � �� �� <br /> v�v_�� F�.:....<.w ,_..:....��.rw... _�.a....,_t�as���x.���:����.;�.r�3;-�s-��r-��-s.���v�r.��s - .� . <br /> >��sra . ..._ _. <br /> Owner's Name 1 t� - IC ��..1 �L Owner's Phone Number �� � <br /> Owners Address � � ) j �1'V�'►Lac..�,�'( y(.,��y/L!�}�lc.LS . 3 �J �� <br /> Fse Simple Titleholder Name Titlehofder Phone Number ��� <br /> Fee Simple Titleholder Address <br /> :��. � '�'SL�"r?`��'�38t'i�'!�'���?�st�RF ;���r`:l�' �ur'�m�.s'�',y'x "�"�#��."�:F.F.��ol`' �.=°� s.N�� x ;-,e�;, <br /> Job Address �jOS� � Z ¢�• Lot# �� <br /> Sub Division � I� OF' ZN.1�M�'�(12,.1�1LS Paroel # <br /> Tr. , . � .�.a' . <br /> ' � Bio-Hazard Waste Storage -ANFtUAL � Fumigation?ent <br /> � Comm Exhaust Kitchen Hood/Duct a Hazardous Material ('fier II or RQ Facility) ANNUAL <br /> _ � Controlied Bum a Hood Installation <br /> � Emergency Generator < 30 kw � LPlNatu21 Gas-Installation <br /> � Emergency Generetor> 30 kw Q LP/Natural Gas-ANNUAl. Sale <br /> a Fire Protection Maintenance -ANNUAL � Places of Assembly-ANNUAL � �� <br /> . r y emi Qn er � l� <br /> Spnnkier � ❑ ❑ ❑ B � Recreational Bum <br /> Fire Alarm �� ❑ ❑ p � � Sparklers <br /> Hood Cleaning � O ❑ O� Sprinkler System fnstatlations <br /> Hood Suppression � ❑ ❑ ❑ � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation a Torch Roofing/Tar Kettle <br /> Fire Pumps a Waste Tire Storege ANNUAL <br /> Fire Works <br /> FlammabieAppiication-ANNUAL o ,�� ValuationofProject <br /> Fuel Tanks <br /> Q Other: <br /> , .;� <br /> Contractor Company <br /> Signature Reg(stered Y/ N Fee Current Y/ N <br /> Address License # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> PLUMBER Company <br /> Signature Ragistered Y/ N Fee Current Y/ fd <br /> Address License # <br /> MECHANICAL Company <br /> Signature Registered 1' / N Fee Current Y/ N <br /> Address License # <br /> OTHEi2 Company t�A'r� FIR+t� -�paJnW.,t�t.S tnc-• <br /> Signature Registered / N Fee Cunent / N <br /> Address j�$fj� N• ��C. .�j Ig License # 4(q $V g ,J�OOO i �9 g � <br /> . <br /> � , . . . ,. . .., _ . ....... , �... , .=.�.ae..�...m.�.Y:.c,,:...a:,..�...v:m.,.aar.e.._... _.._:_ __°__�...t��.,.a..n..: -. _.�:<n�..�.....w.,. "" - �.r.�.� a�. — r............�..« x..�..z..�..�,.a_.,... .'�r::°„£i� <br /> Directions: <br /> Fill out apptication completely. <br /> Owner 8 CAntactor sign back of application, notarized (Or, copy of signed contract with owner) <br /> 1f ov=r 52500, a Notice of Commencement is required (Mechanical work over $5000) <br /> Suopiy two (2) sets of drewings with appiicable documentation <br /> Atlow 10-14 days for review after submittai date. Parcel #- obtained from Property Tax Notice (http://ap�raiser.oascogov.com) <br />