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Permit ApplfcaEion <br /> Date Recatved y + ' � �(3 Phone Contacl for Permlt �� .�a Cf r� ,�' <br /> -�i3JiFaRt1�.��r—r.�t3s.��.��--;,••�-�-�y°.Ai�ud"�$iiti�di� 3i <br /> Owne�s Nama /� L ��%�. �A�.'E �C_ f� OwnePs Phone Numher �� �� � <br /> o�,er.nad�eee �3'7S/ Lr�ttat L f�,a Lfc 1.��rrr,1 �e �G 3 35�� . <br /> Fee Slmple Tltleholder tJame TiUeholder Phone Number � � � <br /> Fee 3lmpte TltleholderAddresa <br /> — •�t•�s.�,.,�#�it"� :�—tr--•:,e_,,��,�,s �.�iY z� <br /> dob Addraes Loi# � <br /> 8ub Dl�lelan Parcal# <br /> � Blo-Hezard Waste Storage'-ANNUA�. _ ' � FumlgeUon Tent • <br /> � Cotnm E�auet Kitchen HoodlDuct Q Hazerdous Materiel(7ler!1 or RQ FeGllty)ANNUAL <br /> � Conirollad Burn a Nood Inalallatlon <br /> � Emergency E3eneraior<30 kw � LP/Natural Oes-Insfel#aUa� <br /> � Emergency(ianarator>30 kw � LP/Natural Res-ATIMUAL 8ete , <br /> QFtre Arotecdon Maintenanca-ANNUAL � Places oi Asaemhiy-ATINUAL �/,�� . <br /> � � � ef � � �J <br /> Sprinkler � � � � � � RecreaUona18um <br /> Flre Alarm � O O C7 � Sparktera . <br /> - - , Hood Cleaning ❑ ❑ ❑ � � Sprinkler Syafem 1na[sitatlons . <br /> � <br /> . Haod Suppresalon � C! O ❑ � � Standpipea(8pdnkler Sya) <br /> " � Ftro Alarm Installadon � Torch Roofingtfar KeH4e <br /> �lre Pumps � a Waste Tire Storage ANNUAL <br /> Flre Worka <br /> Flammable AppllcaUon-ANNUAL . � Valuatlon of ProJect <br /> . Fuel Tanks <br /> Q Other. � � <br /> Contracfor Company .Yr+ %�/�(l. <br /> Slgnafure ./�� Registered Y/N Fee Currenf Y 1 l�E � • <br /> Address ' Ltcense S � <br /> HLECTRICiAN Company <br /> Signeture • � Reglstered Y/N fee Current Y/N <br /> Address Licanse# <br /> PLUMSER Compeny �— <br /> Slgneturo Registered Y/N Fee Current Y/N <br /> Addresa License# , . <br /> MECHANICA! � � Company <br /> Signatura ' Repletered Y/N Fae Cunent 1�/N <br /> Address . Ucense# ' <br /> OTHER � � Gompany � — <br /> 8lgnature Reeistered Y 1 N Fee Curcent Y/I�I <br /> Addrose License# <br /> � �' �' � [gi�lf '�`'liE3/L'� <br /> D�f9C�0I18: � � . <br /> Flll out appl3ceUon completely. � � <br /> Owner&ConUector slgn back of appllceiion,notedzed(Or,copy ot slgned contract vAth a�mer} , <br /> If ovar b�600,s NoUce of Commencemant la raqu[rad(Mechanlcat�Nork over$5000j ' <br /> . • 3upply iwo(2)aets nf drewinga wlth eppllceble documenkatton <br /> • Ailow 10-5 4 days for revlaw e8er euhmitta!date. Percel#-obtalned from Properiy'7ex Notice(http:/lepprelser.pascopov.cam) <br />