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Permif A�plicatlon <br /> Date Recelvea ��,•�� <br /> . <br /> �-_• ,:-riz,,,--�.�_.. ..-r._- -r:: _:;._:;.::. . -- . ... . ._._._..___....�._.�- .. . ...-,. .�.-._... _.... , ._ _ <br /> Phone Coni�ct for Parm(! C������ <br /> L a.�1a:S. .....�:id'...�.� s ...."�i77�i.:,-�.x:' . _-_ ._. - - ..-. . . ._r-" -v� � '„ti'-- t�� _ <br /> Owners Name Owners Phona Number � �� <br /> Owne�S Address r� '� <br /> Fee Slmple Tilleho3der Neme Titleholder Phone Number �� � �!�..4.11 <br /> Fee Simple Titleholder Address - <br /> ���1:X2:•i'Y�:�{'ZX%n��.�R.lY� � ��c" 'NS [�'i,k'+ ' <br /> ��_.5._iff_�..fi� .,.3tix:4�. .?=,�e�Ra:�::'. _-:L�tt:.�T --=p':�^:�+.xt-_.,:}iY,;. :�s --.' -"_ -_ _ _ -_ __ _ __- _ .. <br /> _er� - _ __ --_ _ ;fi:i�,., ..,'�:��.?T•�:;;:::c.::t^:°-.!_tsr'i,i';:�c3`ais:.i� <br /> _ _' _ ... ' � <br /> Job Address Lof# <br /> Sub Dtvlslon Parce!# � <br /> f%;r<F.irar.s-���='eii�t"-Nxxfi:'z?:.:��=�"�S�-T$c';b'3T�F.:�l,"i�1L';.i����.:1.'�v'f3°�T:s_',.�._�_.:__....' s,�. - -:, ii�-.3�:;:',--____�—-- r_vn—<���i.i5v��::iLi::c=i:�!�-.fi.ri:�f3uw:G`ai.z,k:tk`�i�-F,:�vi�,i <br /> � Bio-Hazard Wasie Storape-Ai�tNUAL L Q Fumfga0on Tent <br /> � Camm 6chausl Kitchen HoodlDuct a Hazardous Matedal(Tier II or RQ Facifity}ANNUAL <br /> • � Contralted Bum � Mood InstallaUon <br /> � Emergency Generator<3p�y � LP/Natural Gas-Instapatlon <br /> � Emerg�ency Oenerator>30 kw � EPINaturaE Gas-ANNUAL SaEe <br /> � Fira Protecilon Maintenance-ANNUAL � Places of Assembly-ANNUAt , <br /> -------- ---- -�L�--L��-� Q�- ---- <br /> Sprinkler CI O � � � Recreatlortal Burn <br /> Flre Afarm C7 � � � ❑ Sparkters <br /> Hood Cleaning tl O ❑ � � Sprinkler Syatem Installetions <br /> Hood Suppression � i] � � � � Startdpfpes(5prinkler Sys) , <br /> � Fire A4arm InsEallation � 7orch Roofing/Tar KetUe <br /> Fire Pumps Q Waste 7'ire Storage ANNUAI <br /> Fire Worka <br /> FlammableApplicaHan-ANNUAL Valuatfon of Project <br /> - Fue{T�nks � <br /> � ofher: <br /> �°'u'�r�.���b�Yy�e.w4?.:kzY.�«}'E.'a"cS:�f�i:i:ctiF-Jri`1}��:�:s�.'�'.'��:'�:'!.'V:G:L'::�'^^..iSS.�:SFSi!t�l'.�`.:Cf'vr"'r:..i.:_'I:�.;-.�. _ . - '_ -1[ - - `4•Y'.. �_y.... <br /> --;� .....�:F?:..,.._:. _ .... , _.., -'rs: .?�s:o:�i'tY�:����s.�..,Ftt-,..w.�........;�;i:a:'�:i�.iii�.nitcr8:�?ii�s� <br /> ,Contractor Company ' ; <br /> Slgnature � Registered Y/N Fee Curcent Y/N <br /> Address � �� License# <br /> ELECTRtCIAN Company _ � <br /> Signeture • Registered Y/N Fee Current Y/N <br /> Address Ucense# <br /> P1.UMBER Company �� <br /> Sfgnsture Regfslered Y/N fee Current Y/N <br /> �d�� Lfcense# <br /> MECIiNJICAL Campany ' y� <br /> S(gnsture Registered Y/N Fee Currer►t Y 1 N <br /> Address License# <br /> OTHER Company ' ' <br /> Sfgnaiure Registered Y/N Fee Curreot Y/N <br /> Addrass License# �— <br /> �S r+e+e�''*"" ,t. - ��' � .�,�.,_;:�'2'�'�T'-;rt+.zl <br /> Directfons: � �� , .._. ._. ..._.. -- - , <br /> Pill out appticatian compiete4y. � <br /> Owner&ContraCtor slgn baok of applicatlon,notadzed(Or,copy of signed coniract tivith otmer) <br /> If over$2500,a NoUce of Commencement fs required(Mechanical work over$5008) <br /> Supply hvo(2)sets of draw)ngs wfth applfcabie documenisfton <br /> Allovr 10-14 days for revlew afler submittal date. Parcel#-obtained from Property Tax NoUce(hltp:l/apprafser.pascogov.cam) <br />