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���-�so-oozo c:nY ot tepnymuis rire Fax-a���so-ooz� <br /> Permit Appiication <br /> Date Received �--� Phons Conta�'.t ior Pertnit I 3� � tf 777 <br /> Owners Name Ownsrs Ptata Numbsr �� � CL�t�r� <br /> Oumers Addrass Q I�t I � �1... � �a, <br /> Fee Simple litlsholder Name TiUsholdsr Phons N�unbsr �� � C <br /> Fee Simple Titleholder qddress <br /> Job Address �7 �. � L � �# � <br /> S�0,�8�, �� aa-a�-oL�-���o- v�3��-ov� <br /> [� s�ro wa�stora9e-�NUnt. - . <br /> � F�sr�yatlon Terrt <br /> � �������� a Hwrdous MtEsriat(Tbr II or RQ Facilily)ANNUAL <br /> o ��B�, o ��, <br /> � Eme^8e^cY Gensra�or<30 kw LP/NaWral t3ts-tnstaUatlon <br /> �9a�7'���tor>3�kw � LPMahral G�s-ANNUAL SaN <br /> � Flre Protectlon Maintsnanos-ANNUAL � Placss of Asssmbly-ANNUAL <br /> Sprinkisr L p ��� Rscroatlonal Bum /� <br /> Fire Alarm � O 0 O (�'� g (�� I <br /> L.J PsrM°rs }�l <br /> ` �/ �� <br /> Hood Geankig � O O D Sprirddsr System Install�Ons ;� � <br /> -r� <br /> �-bod suppression ❑ ❑ ❑ o � sandpipes cswinids�srs) <br /> aFre Atartn Ir�stallation a Tor�ch R�ooflnp/Tar Kettls <br /> Fire Pwnpa � Waste Tire Smrape ANNUAL <br /> Rro Works <br /> Flammsbie A�Iicatlon-/►NNUqL Valuafion of ProJect <br /> Fuel Tanks <br /> Q Other. <br /> Contractor � <br /> signature � � � z°ci-ton � <br /> Re9tstered Fee Curront N <br /> ndd�s � uos�# 6 ' �0 5 <br /> �c�icwN �� <br /> signawre Reobbe�d � Y/NJ Fes Cumsnt Y/N <br /> �� Licerns# <br /> PLUMBER � <br /> ���"�° Rep�sosrod Y/N Fee Cumsnt Y/N <br /> �� Ucerns# <br /> MECHANI � <br /> signature Rpists,sd Y/N Fss cumsnt Y/N <br /> Addross �# <br /> OTHER �rn <br /> 5,9,��re � l Y�N I �� Y/N <br /> Addresa Liosnes� <br /> Directions: , . . , � ., <br /> FlU out application carr�pistely. <br /> Own�r&C.ontracta tipn bu�c of applicatlon.rqtariz�d(Or�coPY aF sipnsd corrtract wilh ownsr) <br /> If over b2500.a Notioe of Comrt�a�certisnt is roquksd(MscMnical work wsr 55000) <br /> S�P�Y 1wo(2)ssls of drs�Mnps wNh applicabls doa�tlon <br /> Aliow 10-14 days for rsvisw afber submkfal dats. Pareel N-obtairnd from Propsrty Tax NoNce(MtpJ/apprabsr.p�toogov.eom) <br />