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<br /> Perinit A�plication
<br /> Date ReceEved � _ t� ���� ��
<br /> k:-�ti.sS•ki-..a::.g�;t,:'yii:na:�c.;,�.,...�.�.?3_m°.s. ,. ..;. ....:�,: . ...e. .-�._ ._._..�._,_ �. . • _ , .-_. ... _:_ - . ..-..c.-..-. . .t
<br /> Phons Coniact far Permit
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<br /> O►vne�s Name l.__�4.�-,� '��, Owners Phone Number [��e1_..!-1 � � I`!�.
<br /> Owners Address � �
<br /> Fae Simple 7111eholder Name TiUeholder Phone Number C� � �
<br /> Fee 5impte TfUehoider Address � '
<br /> F�..,. .r—�-�..-..:::':.�.�,.�-.-.�-t'�i-..-'.�:�...-..'i'�-____..'_, _ - — �r�:r - -... _ ��--_ "—, __ _ __ '�k:' _ - _� - .-.y�:j:r1..
<br /> ..,+'�`-:'i�'�-�a�,'_:�r ,:l...tl..i-nle�_�.s�_5i"-+.'4.-.-� 's!L'' - - -- �i'•i_'�"`.'_._ _ _ - _ - :�i'.- .-.1�:� i�..._..�'fi�n�`.',:�..w%i::!c=ai:.n�i�..t_,. in:��
<br /> Job Acidress` �ilt���� �' - - .:;�.l � Lot# �
<br /> Sub Olvisfon Parcel# �
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<br /> .rk�i�:�.?F�IF:ti_:s.�..-.. .-,i��-"'i2'�v'"'.c:.i-r.::1'f_!^cc�s..T � __ ___ve.�
<br /> n a BlaFfaza►d Waste Sforage-lWNUAL Q Fumigalion Tent
<br /> � Comm�xi�aust Kitchen Hood/Duct Q Hazardous Maiedel{Tfer II er RQ Fadllty)ANNlJAL ,
<br /> , • � Controlted Bum � � Hood InstaUat�on ,
<br /> aEmergency Generetor<30 kw a LP/Natural Gas-InsEallatlon .
<br /> QEmergency Generator>30 kw � LPMatura!(3as-ANNUAL Sale
<br /> o Fire Proteciion Mafntenance-ANNUAL Q Places ofAssembly-ANNUAL n Z7 .
<br /> em er_ ��� � - .--
<br /> - --- - -- --- - - --------�-o � �-
<br /> Sprinkler � � � B � Recrealionaf Sum
<br /> Fire Alarm � � Q ❑ � � Spariders
<br /> Hood Cleening � ❑ � CJ � � Sprinkier System InstellaUo�s
<br /> Hood Suppresslon � � ❑ ❑ � � Standptpes(Sprinkler Sys) ,
<br /> a FIre Alerm Inataltailon � Torch Rooflngll'ar Kettle
<br /> Flre Pumps Q Waste T(re Slorage AWNUAI
<br /> �itB 1Morks
<br /> �lammable Applicadon•AMIJUAL Valuatlon of ProJect
<br /> Fuel Tenks
<br /> . Q Other:
<br /> 4. `::5: ' +_'!_','- " _ - a.�t'a _ _ ___ _ " = _' =1`.' - - i\ ';�;
<br /> _ _ _ L.�:' _ _—___' '_ l`1 ti-:`+
<br /> �:�:.�;...�:t:`i. ..i^T3�w veS-+..>..�.4:%uF€t�%35z.:..�.........,_.3:s�i:;2iS::Ci:t�!`:i:....r:_� _,._�.-_� ._.�._.....N�....�......... . ...:.._..... . .�....s��:�P�:eo-:�..,. -x-:�^��.^.':7� �:x.�':i2ii�'sill%x...E±�r3:fr3
<br /> Confractor j ' Company �
<br /> Sfgnature � Regtstered Y/1� Fae Current Y/N
<br /> Address ��icense!�
<br /> ELECTRECIAN Company
<br /> Sfgnature RegEstered Y/N Fea Cunent Y 1 N
<br /> Address ' Ucense# T i
<br /> PLUfu�BER Company
<br /> Slgnatnra f2eglstered Y/N Fea Curcent Y./N
<br /> Address License# ��
<br /> MECHANICAL Company
<br /> Signature Reglstered Y I lr! Fee Current Y!N
<br /> Addcess Ucense#� �
<br /> OTHER Company '
<br /> SlgnaWre Regfstered, ' Y/N Fee Current Y/N
<br /> Addcess Lfcensa#
<br /> ����� � �. � �....._ ::: ._..-_:< . , __.:_�:•..----- -�- �. __�.__��_.,�_:=- .-,----------- - -- •--.._. --- - ---- - .� .a .,-,...w_a-
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<br /> _ _ _a:...'�.�-.- - ��•, ,v=�'
<br /> DtrecUons: �
<br /> FUI ouf appl3caUon compfately_
<br /> dwnar&ConUector slen beck ai applicatlon,notarized(Or,copy of signed contract wltii owner}
<br /> !f over$2500,a NoUce of Commancernent is required{Mechanical work over$5060}
<br /> 5uppiy two(2)aets of drawings wifh appitcable documentat3on
<br /> Allow 10-'i4 daya for revle�v after submiNal dete. � Parcel#-obialned from Properly 7ax fJotice(http:i/appraiser.pascogov.com)
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