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permit AppHcation <br /> Data Recaived _ Phone Coniect tor Permlt _ �� <br /> .,,n,, .__– _– �. _-..��'eun�"��:=:r.'sa.:�+315YL'JCt " ;.nr_.–.u' '' ' --s w- �3.afk _....,–..�nr...p � <br /> - FiIE' - - _— �r.^..'[._.— - tk;+.=:'G ....._�._ �' <br /> �^ � ~ O�vner's Phona Numbe� � � <br /> Ownera Neme <br /> Ownere AddreBS � t � ` r <br /> Fee Slmple TlHeholdar Mame TiUaholder Phona Mumber C� � � <br /> Fee Slmple 7ltfeholder Addrasa ---- - <br /> . .. ' 1;=,4�:n,w •`+et"-16�aty;ts?i.w`Ljialtt'�`'j;.-Ct_i�iii��;;v?�7i-3��Nar»It,�,--��'I'..a�t•#:tzC�Is-k�.:�¢4�t4��lSiG��'�3?r�FS.3�!lt�S't'-Nt��'Al�u,4dYey�rXttc9�'t'-.l':�. <br /> .tob Addreea � � Lot# � <br /> Su6 Divlalan Parcel�! _ <br /> - ir;ez*-.r r::3T.�'s3d:�8tirt:i�+��:,-G•�'�:drK!?*��iiFlL-Yai — tii5�.e <br /> a BlaHezard Wasta Storeqe-AIJNUAL � FumigaQon Tenl - <br /> � Comm Extieusi Kltchen HoodlDuct a Hazatdous Mala�iei(Tler!I or RQ Fecllily}ANNUAL <br /> Q Controlled 8urn � Hood Installation <br /> 8 �mergency Deneraior<30 kw � LPlNatural Gag-Inatellallon <br /> Emer�ency Oaneratar>30 kw LPlNaiural Oae-ANNUAI Sale <br /> � �irs ProtacHon fulafnienence-ANNUAL � a Places of Assembly-ANt�UAL y� � '���_j <br /> � em � er ❑ -1-^ <br /> Spdnlciar �fS+ A O RecreeGonel eum <br /> F{re Afa►m D ❑ � � 5parklars . <br /> • . fiood Cleening � D ❑ � � Sprinkier System Instelladons <br /> Hood Suppresslon � ❑ ❑ � � � Standplpes{SpAnkler Sys) <br /> ' Q Flre Atarm fnataflellon � Torah RoofinglTar Kattle <br /> FI►e Pumps � Waste 1'ire Storege ANNUAL <br /> Flre Works <br /> Flammable AppNcetfon-ANNUAL Valuat(on of Praject <br /> Fuel Tanks <br /> Q4thar: � _ _ � ' <br /> - - - - .,.-�-��s�-�,at�_,�t��=.:�:�.�:�:�...��--. .� <br /> Contractar � Compeny , <br /> s��na�ure Re9�ete�ed /N Fee Current Y I N • • <br /> Addresa r lJcense# _ <br /> EI.ECTRiGIAN Company • <br /> $[gnaRure ' Reglstered Y 1 N Fea Curcenk �(/N <br /> Addresa Llcense# <br /> PLUMBER Company _ <br /> Slgnature Regfstered Y/N Fee t;urrent Y/N <br /> Addrese Licsnse# � <br /> MECWWICAL � Company <br /> 3lgneture Regfstered Y/N Fee Cument Y/N <br /> Addresa Ucanse# ' � <br /> 07HER � Company ' <br /> Slgnature Replstered Y/�I Fea C�ur�enE Y 1 N <br /> Addresa Ltcense# <br /> � - ---- e��,.n��o-t°�rak:�-v... 3S�.ez.�raaa:�iYUa <br /> Directlons: ' ' <br /> FlII out applicettan compfetety. <br /> Ovmer&Coni�actor sign back ot appllcation,noterizad(Or,copy of slgned conUact with owner) , <br /> I{over$2600,a NoBce of Commencement fe requlred(Mechanfasl work over$5000) ' <br /> Supply iwo(2)aets of drawinps with applicable documentefion <br /> • Allow�0-14 days for revlaw aftar aubmlltel deta. Parcel#-obtalned from Prope�ty 7ax NoUce(http�llappreisar.pascogov.com� <br />