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<br /> f'ermit Appiication
<br /> Date Received Phone Coniact tor Permit
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<br /> Owners IVama Owners Phone Numbar � � ��
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<br /> o,�,�r$Aadress
<br /> Fee Simple Titleholder Name Titleholder Phone fJumber C� � �
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<br /> � B10-Nazard Waste Storage-ANNUAL � Fumiga@on Tent
<br /> � Comm Exhaust Kitchen HoodlDucl � iiezardous h�4aterial(Tier If or RQ Facility)ANNUAL
<br /> � Conlrolled Burn � Hood instalistion
<br /> � Emergenay Generaior<30 kw � LP/Natural Gas-InstalleUon
<br /> � �merge�cy c3eneretor>30 kw a I.P/iJaturat Oas-/1NNUAL Sale
<br /> Q Ffre Profectlon Maf�tenance-ANNUAL Q Places of Assembly-ANt�UAL
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<br /> Spftnkler �j D ❑ � � Recreational8um ��
<br /> FfreAtarm � ❑ p O Sparklers '
<br /> � �
<br /> Hood Cleaning � ❑ [] ❑ � � Sprinkter System Installadons
<br /> Hood Suppresslon � ❑ o ❑ � � Standpipes(Sprinkler Sys)
<br /> � Flre Aterm Instailatlon � Torch f2oofing/Far Kettle
<br /> �fre Pumps Q Waste 7ire Storege ANNUAL
<br /> Fire Works �
<br /> Flammabie Applica8on•ANNUA�
<br /> Valuation of Project
<br /> Fue�Tanks �
<br /> Q Other:
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<br /> Contracior �`"`�. Company '
<br /> Slgnalure Registerect Y/N Fee Current Y/N
<br /> Address � �(�}License# �� —�
<br /> ELEC7RIC(AtJ Company ����
<br /> Slgnature Registered Y!N Fee Current Y!N
<br /> Addreas Licensa#
<br /> PLUMBER Company �
<br /> Slgnature Registered Y/N Fea Current Y/N •
<br /> Address Llcense# _�
<br /> MECHANICA{. Campany r
<br /> Signature -»-�------
<br /> F2egistered Y J N Fea Current Y/N
<br /> Address Licertse# —��
<br /> OTHER
<br /> Company ���
<br /> Signature Regfstered Y/N Fee Current Y/N T �
<br /> Address License# �—
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<br /> Fill aut appllcaUon comptetely.
<br /> Ovmar&ConVsctor eign badc of applicatfon,nota�ized(Or,copy of signed conVact�v�th owner}
<br /> !f over g250U,a Notlee of Commencemant is required(Mecftanlcat worlc over$5000)
<br /> Supply iwo(2)s�ts of drawings wlth appflcable documentatlon
<br /> Ailow 10-14 days for ravlew aRer submitial date. Parcef#-obiained from Proper(y Tax hlotice(hUpJlappralser.pascogov.com)
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