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Permft Appiicaffon <br /> Daie Recetved ` �— Phone Contacl for Permlt � � � �,��� <br /> t�'isTa+6/tlrs-+`ru�r r ---r,��'^,�'��Jte��c—aHr"aJS�F�irrc��.c:,�,'�1:�sL^:era:=Jes�c+��� <br /> Ownera Nama O��mers Phone Num6ar � � <br /> Owner's Addrees � L ` <br /> Fee 8lmple Tldeholder tJeme 7Nehoider phone Numbet C� � � <br /> Fee 31m e7ltleholderAddress <br /> � s.��u�4e£�-°—'39aw�Y' a' va -r��'��av1r�'iF�2sv+'��L::•�fF3S.s�i!3sF�3..Kf�ttLTFSi.��i��9�'�..+�_s-�=l18�L'�l � <br /> --�:s!'f'�� .�,.�.t1�Wl.Ylsx1 - <br /> Y <br /> l � �� LO�# <br /> Job Addreae <br /> Sub Dtviston P$«�� - -- <br /> .y . - �r��;��—�;n.:�,����_�..-�.vJa.—:i.�.r•�:+ci:2.z�it�e <br /> � BfaHazerd Wasle Siorage'-ANNUAL . ' o Fumtgatlon Tent ' <br /> a Comm Exheuat Kttchen HoodlAuct � Hazercious Matedel(Tier I{or RQ FaGilty)ANNUAt <br /> � Controlled 8urn � Hood inslelletlon <br /> � Emerpency GenaraEor<30 kw � LP/Naiurel Gas-Instelladon <br /> � Emareency(3enerator>30 kw � IP/Natura!Ges-ANNUAL 8ele <br /> � Fira Protectlan Malntenanca-ANNUAL � Plecas of Asaembly-ANNUAt - �� �I <br /> . � am (A��Tn er � ;� ' <br /> &prfnkler �. [7 ❑ Recreatlonal Burn � <br /> Flre Afarm i3 ❑ o � Sperkfers _ <br /> . . Hood Cleaning � � o n � Sprinklar System Inatetlatloos <br /> Haod 3uppreaslon � � D C] � � Stendplpas{Sprinkler Sys) <br /> � FEre Alamt instellatlon � Torch Rooflng/Tar Ketlle <br /> F�te Pumps � Waste Tlre Storege ANNUAL <br /> f�f8�ll/Of�(6 � <br /> • Flemmeble AppllcatEon-ANNUAL VelUBtlOtt Of PYOf 8C� <br /> Fuaf Tanks , <br /> � Ofher: -- - - -- <br /> - ,,� � _—.u_,�..�=-��,:r��rc��::�.��.�_�� ��`� <br /> Contractor /,,,, f ����� /.1n ,�,, � p Company • �� . <br /> Slpne[ure ��� .L�..}�,! �(.X,.1 V1� � Repistared Y!N Fee Current Y/N <br /> Addreas r tJcense# <br /> �LECTRICIAN Campany ' � <br /> Signature ' Regislered Y 1�) Fee Currenl Y/N <br /> Addresa Lfcense 1! � <br /> PLUMBER Company <br /> Slgnalure Regiatered Y!N Fea Current Y 11� <br /> Addresa ����5�# � <br /> NfECHAN[CAt � � Company <br /> 9lpnaiure Reglstared Y/N Fee Curtent Y/td <br /> Addtase • Wcense# — <br /> OTHER � Compeny ' <br /> St�nature <br /> RegEatered Y i N �ee cuaent Y/N <br /> Addteas Llcense!1 <br /> ,�;�•�.� •ktiYcii'.IfAJ <br /> Directlons: � <br /> F111 out epp3(cedon complate►y. <br /> Owner 8 Contrector alpn back o}app�icellon,noterized(Or,copy of atgned contract wllh owner) . <br /> If over$2600,a Noilce af Cnmmencemant Is required(Mechanlcal�vork over 36000) <br /> 3upply iwo(2)sets ot drawinpa wlth appllcable documentation <br /> Allow ta-1 A days for revlaw efter aubmlttel data. Parcel!l-obtalned from Prope�ty Tax Nofice(hltp:l/appralser.pascogov.com) <br />