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, <br /> Permlt Appllcation <br /> paie RecelJ�d � ;z 2 �l.�� Phone Conlac[far Permit � �� _ ���� <br /> � - ._� Y6�I�i'R�i`s+-?iTS7:,:i•W1�i..=2:;`=�'.,�'�4u•=-;�:Lu.�i_._eFir:i-,�L�i;_'.�:�'��T-..+`�s' .�v L . . _. .ti. -�._�. <br /> Ovvnere►Jame Lf � � � �f/�j +���l1r? Owne�s Phone Number � I�J I __� <br /> Owner'sAddreas 7e3�v I�1i4i1�° � �L�,� /��•� ,,�.JJ��� . <br /> Fee Simpte TNlahotder Name TtUehofder Phona Number � � � <br /> Fee Simpta Titleholder Address <br /> �' s'� � i!#u:':Lt..'`:vi:,—,.,;itl:i'd:� ��'� ��'Sav i�:.i:;tt6':�'�:.',�"''�t'.:��,sf.,�u-'ln4 tx.�n"�as`[slbii'a`$�T�:Ji%tL:iiHl`L:ieF� � <br /> `r�t�,a- <br /> Job Addreas Lot�! <br /> Suh Blv3slon Parcel# <br /> ]srF.I.6.Y�[ii�73lHekv�iaLS�'aYE:�TIii=�'i-.'`-�:ix?1„£H5A*c':�i�T�T.'�s�•�r•:�''aR?':�?SlIG4'iiK';vn�erzua:�:�Hrt-�`e13t1"�S�?.i�F�$tl����YF:.35'yF!iiE1 <br /> � Blo-Hazard Wasie 5tore8e-ANNUAL , � FumEgaUon Tent • <br /> � Comm Exhauat Kitchen HoodlDuct � Hazardous Materlal(Tler!t or Rl]Facillty)ANNUAL <br /> � Gontroiled Burn a Hood tnstatlalfon <br /> � Emargency Generaior<30 tc�v � LPlNaturel Oes-lnstellatlon <br /> QErnergancy Oenerefot>30 kw � LPINalural das-ANNUAL Sale <br /> a Flra Protsc0on Meinienance-ANNUAL a Places of Assamhly-ANNLiAI. `� /�� ' <br /> �� em Q er ` <br /> Sprinkler � D � � Recreattonal B�rn � <br /> Flra Alarm � CI O O � Spariciera _ <br /> - . Hood Cleanlnp � O a O � Sprinkler SysEam InstellaUons <br /> Hood Suppreselon � 0 O � � � Stsndp(pes(Sprinkler Sysj <br /> ' � Flra Alsrm fnslalladon � Torch Rooflnpl7ar Kettle <br /> �ife Pumpa a Waste 71re Storage ANNiIAL <br /> Fire Wwks <br /> Flemmable Appllcetion-ANNUAL Valuation of Pruject <br /> Fuel 7e�ks <br /> � Other: � ' <br /> �.u�:�: -,�s�_r-=-�°n�.��C�r�:_��.'?�-:;.��-_...�-,; �: �v�t;�`.�3'�!:c,,;��-.:i:�� <br /> Cnntractor . � Company •'7+}s �fC ' K��C <br /> Slgnature Registered Y/ Fee Current Y/N <br /> Addreea Licenae# <br /> ELECTRICIAN Compeny __ <br /> 8ignature � Reglsterad Y 1 N Fee Current �l J N <br /> Addreas 1Jcense#� <br /> PLllMBER Company <br /> Slgnatura Regisiared Y/N �ea Cutrenl Y/N <br /> Addresa L�cense# _ _ <br /> MECHANICAL � � Company _ <br /> 5leneture ' Raglstered , 1�/N Fee Curreot Y!N <br /> Address Ltcense# ' � <br /> QTHER � Company ' <br /> Slgneture Raplsfeted Y/N �ee CuRent Y/N <br /> Addtesa Ucense# � <br /> ,.,. - "�: ._ -:=i!�',s�•�r?lJd�:r w'.r,:F!! - "i,-?fir4tirilni <br /> blrecNons: ' <br /> FIN out application completaly. <br /> Ownar 8�Conlrackor slgn back of epplicailon,notarized(Or,capy of signed conirac!�vllh owner) , <br /> If ovar$2500,e NoUce of Commancemenf 1s requlred(Mechanical�voric over$5000) ' <br /> Supply iwo{2)sete of dravAnps wlth appllcabfa documantation <br /> • Allow 90-14 days for revlaw after submlttet date. Parce!#-obtalned from Prope�ty Tax Noilca(htlp:i/appralser.pascoDov.com) <br />