Laserfiche WebLink
� <br /> F'erml!Appllcation <br /> Date Recelved � Phona Coniact fbr Permlt �� <br /> ��'"='�' rR.�s:�7rkt�tr--;,�i;:-r—�����,:nP-..-���-_.�.on:tr - <br /> ���at�ias�i+ni� <br /> �wnera Neme � �L ��, "��� •Ovme�s Phona Numbet t� �� �� <br /> Ownara Addreea � � ` t�'a , <br /> Fee Simple TJllehotder Neme Titleholder Phone Number �� C� �� <br /> Fee SEmple TitleholdarAddreas <br /> � �f��i.�,x'_.,,'iAs f,ii��x. Sj2"n:tJ3::n.i,x'Iti.:f1iE,�.�.]F�4:LA.:.t�}9`b"Ls ke.`ta....,s...iu.l,c�.�da•wsa rii.u.::s+s..afi��=� - - :��.-�xix4��ie <br /> Job Address �� , ;�� ^� � 0 <br /> ` �� d� Lot# <br /> 8Ub Dlvtalan Parcef# <br /> !"�tA'RYr7Ii7S�i�&FR"a�7f��f^�^}��h'st��r ,-}y,�yy,y'i3tFftifrTdlL'FilT7�,.:A.'�fy"�sL�.Yii:s �� - <br /> � �.a�� . <br /> Blo-NazaM Wasle 3torage-ANNUAL � Fumtgaitan Tent <br /> � Comm Exhauet Kltchen HaodlDuct � Nazerdous Meteclal(7'lar II or RQ Fac{Iity)ANNUAL <br /> � ControAed 8urn � Hood InatallaUon <br /> aEmargency Genarator<30 kw a Ll�Maturat Oae-InatellaUon <br /> � Emergency Oenarator>30 kw a LP/Neiurel Dea-ANNUAI.9e1e <br /> � Flra Protection Mainianance-ANNUAL a Places of Assembly-ANNLIAL � <br /> . ]FA em AnT er <br /> Spdnkic! � ❑ ❑ � � Recreat(onai 8urrt <br /> Fire Alarm � p O iffi Sparklers <br /> � <br /> � • kaod Cieaninff � O Q ❑ � Sprinkler Systarn Insiellallons <br /> kood Supp�easton � Q ❑ D � � Siandpipea(Sprinklar Sys} <br /> � Fire Alarm Installat�on a Totch Rooflng/fer Kettle <br /> Fire Pumps a Waete Tire Storege ANNUAL <br /> Fira Warks <br /> • Flemmebte Applicatlon-ANNUAi. Valua#fon of ProJeot <br /> Fuai Tanks • <br /> � Ofher: . <br /> - T.�•.�..,�n�,..�:����:��s�����r��� ��� <br /> Contractor ? � � Company <br /> Sipnature �1 I�"^""' ' Registered Y 1 N Fee curcent Y/N <br /> Addresa Llcense# <br /> ELECTfiIC1AN Corrfpany <br /> stQnature • Reeistered Y/N Fee currant �Y/N r <br /> Addtesa U�BB� <br /> PLUMBEIt Company �� .� <br /> 6lpneture Regfatered �_ Y/N .J �ae Current Y/N <br /> Addreae License# � <br /> MECHANICAL � � Company <br /> 3lgnatura Reglsteied 1�/�1 Fee Current Y/N <br /> Addreas � License# �'- - <br /> OTHER � � Gompany ' . <br /> 8lgnature Registered Y/N Fae current Y/N <br /> Addrees Ucense# <br /> Dlrecilona: - - �..•��;,,'�,r�:�.�,�� � <br /> r �S�i2.�t'�� <br /> FIII out appllcsUon completely. <br /> Owner&Contraclnr slgn back of appUceUon,noiedzed{Or,copy of slgned conirect wlfh owner) <br /> !t over 52600,a Notice of Commencement ts required(Mechanical work over$8000) ' <br /> 5upply lwo{2)aeta of drswinge wiih eppllceb}a documentatlon <br /> - Allaur 10-14 deye for revlaw after aubmlttaf dsle. Percei Il-obtafnad from i'roparly Tax NoBce(htipJlappraleer.pascogov.comj <br />