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Permit Appllcatlon <br /> ' 's d�� <br /> Dete ReceEved �� '2{'�,�f�� Phona Contect for Pamsit � � <br /> - _�.��-..�--��.�ers��+rt.��� . <br /> Ownar's Nema � �� �� /yt�l. Owner's Phone Numhar �� � � <br /> Owne�'e Addrese �v Z�J'� �� ��'L � _� � ���' ' <br /> Fae 8lmple TIlleholder Name TiUeholder Phona Wumber � � r_� <br /> Fea 8lmple Tltlaholder Addresa /�{y�R(,YR� <br /> - ' T�FfflL#h"�t35�!�i�'�"�''�-�'"" • �`�i�'�:��'�'��$jan+a��°�`et�Thf1�����6b'.'`�f�eA�L.aaJAZa�LL���'sx�� <br /> JobAddress Lat# � <br /> 3ub Dlvlelon Parcel# <br /> � BlaHezard Waste Storega'-ANNUAL , - � FumlgeUon Tent ' <br /> � Comm�xhaust iQtchen Hoaf/Duct � Hazerdous Matadal(Tler II ot RQ Facll(ty)ANNUAL <br /> � Controlled Bum Q Hood InstallaUon <br /> � Emergency Oenerstor�30 kw � LPlNafural(3es-Installa@on <br /> � Emerganay Genarator>30 kw � LPlNafurel(3ea-ANNUAI Sale . <br /> � �ire Protectton Mieintanance-ANNUAL � � Places of Assembly-ANNUAL <br /> � em [A�n er � j 2�j i� <br /> Spr{ntcler � Q ❑ ❑ � � Recreetlonal Burn �V� <br /> Fire IUarm �� ❑ � O ❑ Sparklera i , <br /> - • . Hood Gleaning � Q ❑ o � Sprinkler System instaltadona <br /> . Hood Suppresalon � � n o � � Standplpes(3prinkler Sys) <br /> ' a �fre Atarm insfalla8on a Twch RoofinglTar KeNle <br /> Flre Pumps Q Waste Ttfe Storege ANNUAL _ <br /> Flre Works <br /> • �lemme6faAppltcadon-ANNUAL . VaIUHf�oIlOf�fO�BCt <br /> Fuef Tanlcs <br /> � Other: � ' <br /> Contractor � Cornpany ��.+ t�}� r�iiaist�'!-� <br /> 8lgnature Reglstered Y! � Fee Curcent Y/N � • <br /> Address � ilcensa# ' <br /> EL�C7RICIAIV Company • <br /> Slgnaiura • ' fteglstered Y/I� Fee Current Y/N <br /> Address Ltcense# � <br /> PLUMBER � Compeny <br /> Signa{ure Regrstered Y/N Fee cur��t Y/N <br /> Address Llcense# • � <br /> MECHANICAL � � Company <br /> Slgnafure ' Registered Y/N Fee Current Y/N � <br /> Addreas . Lteense# ' ' <br /> OTFiER � Company � • <br /> Slgnature Registered Y 1 N Fsa Current Y/N <br /> Addrese Llce�se# <br /> - _ +HFrc.�ts*�'���C":'d.'k <br /> D�feetf0116: ' , <br /> Flll out appllcetlon compfetely. ' <br /> Owner�Conireator elgn bactc af eppltcaUon,notarized(Or,copy of signed cantract wlth owner} , <br /> It over�2600,a tJollca of CommencQment Is requlred(Mechantoal�vork over$6000) ' <br /> � • 6upply two(2)aets of drewinps wllh appllcebte documentatlon � <br /> • Atlaw t0-14 days for reviaw afler submlttal date, Percet#-obtalned from Properiy Tax NoUce{hUpJ/appraleer.pascogov.com) <br />