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<br /> Permit Application
<br /> Dale Received
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<br /> Phone Contact for Permit
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<br /> Owners Name Ownars Nhone Number C.�L� �
<br /> Owne�s Address • � . .
<br /> Fee Simple 7itleholder Name TtUehofder Phooe Number C� � �
<br /> Fee SlmpEa Tltleholder Address
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<br /> t �Job Address Lot#
<br /> Sub Division Parcel#
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<br /> � Bio-Hazard Waste Storage-AtJNl1AL a FumigaUon Tent
<br /> � Comm Exhaust Kitchen HoodJDuct a Hazardous Materlal{7ter 11 or RQ Faciliiy}ANNUAL
<br /> QControlled Burn � Hood lnstallaUon
<br /> � Emargency Generator<34 kw � lPliValurai Gas-lnstalfaE3on
<br /> � Emargency Qenerator>30 kw � LPMalural Gas-ANNUAL Sale
<br /> � Fire Protectiort Mai�tenance-ANiJUAt � Places of Assembiy-MINUAL
<br /> �y emi � er ,!
<br /> Sprinkler � ❑ f� T�t, � ReCreationalBurn �LLj�
<br /> Fire Alarm � ❑ 0 O � � Sparklers �' � ` �/
<br /> Hood Cleaning � O � � � � 5prinkier System Instailadons �
<br /> Hood Suppression � fJ ❑ ❑ � � Standplpes(Sprinkler SysJ
<br /> oFira Alarm insteltation � Torc3i Roofing/Tar Kettle
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> � Fire Works
<br /> eFEammabie ApplEcalion-ANNUAL ��--� Valuation of Project
<br /> Fuel Tanks
<br /> Q Other:
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<br /> Contractor Company
<br /> Signalure ' Registered Y/N Fee Curcent Y/N
<br /> Addr�ss License# ���
<br /> ELECTRICIAN Company �
<br /> Slgnatura Registered Y/N Fee Current Y/N
<br /> Address License# —�
<br /> PLUHSBER Company
<br /> signature tte9�6tered Y/N Fee current Y/N
<br /> Address Licanse#
<br /> MECHANICAL Company
<br /> Signature Regisfered Y/N Fee Curcent Y/t�!
<br /> Address Ucense#
<br /> OTtiER Company
<br /> Signature Registered Y i N Fee Current Y/N
<br /> Address Licanse#
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<br /> Dirnctions: - ---------------
<br /> FIl1 oui eppffcation oompietely.
<br /> Owner&Cortiractor sign back ot appiication,noterized{Or,oopy of al�ned conUact with ownerj
<br /> [f over$2500,a lJotice of Commencement ia required(Mechanical work over$5000)
<br /> Supply lwo(2j seb of drawings with appitcable documantaUon
<br /> Allow 10-14 days for review after submittal dale. Paroel#-obtained from Properly Tax Notice(httpJ/appraiser.pascogov.00m}
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