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. �i�-7eo-oczo C.ity �P7_e�h,yrhifls Flr� rar,-813790-00
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<br /> o"mEr��tvam� DurtYeY�S Pfrerre N1umCrer C��1�
<br /> Owner's�dr�ros, 3— 3,
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<br /> Foo Sim�lr_Titlahoider Name
<br /> Tlflohseleler�+hena Wumfsar �
<br /> Fee S1mple�Titl�holder P�dclre�s
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<br /> „on Address � � p � 1"L__ Lota�
<br /> Sub Dfvisfon P�mel�
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<br /> o13ic MszaM Waste Stc�rage-AIVWUAL � Fmr!qlg8$lan TofTt
<br /> n CQmm Exhaust Y.it�hen HaodlDuct � hlazardows Matariel(Tiar�I or RQ Facill�j)aNt�uA•(:
<br /> �i cont;Ol�E�d BWT �j !�nod�rrs�a�l�tton
<br /> � Emeraer,cy G2nE��t^r �0 V.w � LPINJah,ir�i C'�s�lrrs�!!'at�on
<br /> � Energency Gar,z��or�3C1 kw � LPIiV�tursl 33s-��f�71:f�L Sale
<br /> � =;^°_ p^a�acJor,���a ntecanca-AiVrkr�1JA�L � ?lacos of A�sembly-ANNWAL
<br /> 11��^^��L::��1 ._.�..._mi f� .� er i
<br /> Spri.•kler � C D _� �J o Racraatfenal F3um �l LY�(J
<br /> Fire Alarm ❑ r; '' ��� � Sparkfers ( �
<br /> \hlrsocl t�laarnng �f ❑ � � a Sprfnkfar Syst�em Insiafis�ttcsns
<br /> Hoad Svaprasaian � r ;� � � 5{�ndplpgs(5prin{�Car Sys)
<br /> � Fir2 Alarm Instai!at�on � Torch Roe�RnglT;ar Ka�tle
<br /> Firepiamps � Wastalice5'teraga•AhIkGU,bL
<br /> Firs�WaNc,
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<br /> �lamrnahle A:plica;ion-AkINIJAL Valua�ion ef Prpj�ct
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<br /> CO!1�I'9C'CCi �----�„.. C411T1�iJ�t'lY
<br /> •lrn�t�;rr: RagfstaraG 1`�I Fee Cur�ant N
<br /> Addre�s ,� Lioense# '
<br /> ELECTrZICIAh! Cempany
<br /> S1r�nature � j Rec�lstsrad 4'/hd Fee CWn�nt `Y"/�N
<br /> Addrsss �� � L.ic9nse#
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<br /> ('�U�'�l3EP. � � Ccmpan,y
<br /> signazure � �� ; Rggistered Y/1'd Fee Cwcrsnt +Y/ IV
<br /> nddress � _� L�conse#
<br /> MEC}-IANICAI_�+ �
<br /> SI nature � Company
<br /> 4 � Ragisterar� Y/N Fee Currant Y i 1`d
<br /> /�ddress � Llcsrtse#
<br /> �T��� � I Cnmpan,y
<br /> Sianacurn � I RagfSterad `�'/1t! r �ee CuR'ent� Y/1`'��
<br /> Acidrmss I:IaORSe#
<br /> C� nawu„aruvn waaurw`ewiuu:w,��mu�.�xnuo�w.aa � iuuum.naunawwvuwnr.ru,nio rt+uu�uaur.r�iwnvartw�nwe, r�uuara wenmi�l
<br /> (�ifEGtiOnS.
<br /> �II out appfiaatfor,complately
<br /> Owner&CanCractcr sign bac1:o`�ppHcsYior,notan7od(rr,r..r,py�f sigr,eN r,on'Cr�ct with ownsr)
<br /> P`ov2r 3��u0, a Notice of Commr�ncameltt Is requirer.;(ti1e,^haniral�Nnr4 ovar�5000)
<br /> Sunalv two(�1 eets nf Cnw�n9F�+rith 7pfF�«lhln dn.r.�.im�nt:�'iar.
<br /> Allou� '10-'ia days;or rau;�"�.a�-or�,�bmittai�aeo. F�rca��t-ont�inod from preperty Tax�IVatl�e(fittp:/lapprarser.pasangov.00m)
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