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<br /> Data Recelved Phone Contect tor Permlt t� � 3� Y ,,
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<br /> Owners Name Owne�s Phone Number t� � �
<br /> Owners Address �
<br /> Fee Simple Titleholder Nama Titleholder Phone Number C� � �
<br /> Fee Stmpte T(@eholder Address
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<br /> Job Address ~� �..• � Lot# �
<br /> Sub O(vislon Parcel�l �
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<br /> Q BiaHazard Waste Siorage-ANNUAI. Q Fumlgallon Ten[
<br /> � Comm Exhauet iQtchen HoodlDuct a Hazarc3ous Material(Tfar II or RQ Facilily)APlNUA�
<br /> � a Conirolled Burn � Hood insiella[lon
<br /> Q �mergency Generator<30 kw � tPlNatural Gas-Insfaflation
<br /> � Emergen�y Oenerator>30 kw � LPlNatural Gas-ANNUAi.Ssle
<br /> � � F(ra Protectlon Maintenence-AtJNUAL � Places of AssembSy-ANNUAL .
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<br /> Spdn [] ❑ � RecreaUonal Bum 2
<br /> F(reAlarm ❑ 'f�Q, � Spar[cfers r � .
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<br /> HoocE C3eaning Cl [] O � Sprinkler Syatam Instaliadons
<br /> Hood Suppress(on � O ❑ � Standpfpes(Sprinkler Sys} ,
<br /> a Fire !nslallatEan. Q Torch RoofinglTar Kettle
<br /> ffre Pumps � Waste l7re Storage ANNUAL
<br /> Fire Worlcs
<br /> Flammable Appllcatfon-MlNUAL Vatuafion of Project
<br /> • Fuel Tenks �
<br /> Q Other:
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<br /> Contractor �""'4^ Company �
<br /> Signature Registered Y/N Fee Currenf Y/N
<br /> Address Lfcense# --�
<br /> ELECTRICIAN Compeny
<br /> Signeture Registered L Y/N Fes Current Y/�I
<br /> Addrass Ucense# �
<br /> PLUMBER Company ��
<br /> Signature Regisiered Y!N Fea Current Y 1 f� �
<br /> Address LEcense#
<br /> MECHANICAL Company �
<br /> Signature Registered L Y/N Fee Curcent Y!N
<br /> Atidress License# —�
<br /> OTFEER Company " �
<br /> Sl�nature Regiatered Y/N Fea Carrent Y!iN
<br /> Address License# �- —�
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<br /> Direc@ona: - - - , -- %:�.�,5:�->�
<br /> Ftli out applfceUon completely_
<br /> Owner&Contractor stgn beck of appiicetion,noterized(Or,copy of slgned conUsci wllh ownerj
<br /> If over S2b00,a NoUce ot Commencement ts required(MechanEcal work•over$5000)
<br /> Supply two(2)asts of draw3ngs►viih appllcabfa documentalian
<br /> A11rn�10-14 days for rsvlew after sabmtQat deie. Parcel#-obieined irom Property i"ax Notice(httg://appralser.pascogov.com)
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