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<br /> s�s.7aaoa2o City of 2ephy�hills Fire ��8is-7ao-oo2�
<br /> Permit Application
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<br /> awner's Name . �i 1 y c.��-t ' �T �"v'�.D Ownet"s Phone Nutnber �� � ��
<br /> Owner'sAddress �7�Df f-¢r�"f�f�l�.C., GGL QA ��,O�fs/'2/�l�,S �-�' '�'."'�j.�� �
<br /> Fee Simple TitleholdeR�NBme ��� � Titlehalder Phone Number � �� t�--�—�
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<br /> ��a S�mple,TitleholderAtldress'
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<br /> JcbAddress ����/ �^'��i G��• � ��tt"�"l�/t{/L�.� ��t✓��J�"t"l l.ot# ��
<br /> Sua Divi,ion ���
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<br /> �.,v«:SiaHazard Waste StArage-ANNUAl. � Hazardous Materiai(Tier!t or RQ FaCility}ANNLlAL
<br /> � Comm Exhaust 1Gic�en NoodlDuct � Hoad instailation
<br /> � Cantre!!ed Bum ,� � LPIFIa#uret Oas-insfaliation
<br /> � Emergency Generatar<3Q kw � � LP/Naturai Gas-ANNUAt Sate
<br /> _ � Emergency Ge,�eratar>30 kw � Places of Assenlbiy-,Ai�fNUAt
<br /> � Fi:e Proteciion Maintenar=ce-ANNtiAL � � iiecreationai 8um •-7-.
<br /> �r e'r" �n er ���//
<br /> Sprintcier � ❑ ❑ Q � � Sparkters (
<br /> Fae Alarm � 0 C] � � � Sprinkler System instaAations t
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<br /> Hood Cleaning � D ❑ O � � S4ittdpipes tSP�n���)
<br /> Hooc.Suppcessian � �d ❑ O � � 7arch RoofiaglTar Kettle
<br /> � Fire Alarm lasta{latian . , � Waste 1ire Storage ANNUA�.
<br /> � Fire Pumps
<br /> Fire iNorks
<br /> � �lammabte Apptication-AHNUAL Valuaiion of Project
<br /> � FuelT3nks
<br /> ❑ other. �
<br /> r,a+.�+.y�.�, JxY�'lt.x"rJSF�:a4>���y..`9. 44 sry�cp�ynx� ,�:1••
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<br /> Co�t,actor COmpar►y 'T�p t tu'1�f'O n
<br /> Sionaiure Ftegisiered Y/N Fee Currant Y 1 Itt
<br /> Address 35 31 lfse �,�en� Rd. '. Lieenae� FO00 �j
<br /> :.,ECTKlCIAN � COmpanY
<br /> �i;naiure rteg�scered � Y/N Fee Cuttenf Y/N
<br /> ,�ddress License#
<br /> Y�'vhiBER Company
<br /> 5iy^nature � � Registered Y/N Pee Curcent Y!N
<br /> Adaress License#
<br /> ntECtiANiCAt ' COCnQany
<br /> Signatwe � Registered Y.I I� . Fee Curcant Y/iV �
<br /> Address LiGenS6#
<br /> OTHER Campany
<br /> S;gnature � Registered Y 1`1V Fee Curcent Y 1 N
<br /> AGdress � !1U'eRSB#
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<br /> �lrections: _ � �
<br /> firi aut appiica6on compietety. •
<br /> Qwnes&Conlracfcr Sign badc of applica2ion,natarized{O�,copy of signed contracf with owner)
<br /> !f over 525QQ,a Natice of Commencement is raquired{MectianiCal wotk over 55000}
<br /> SuPP�Y wro(2)seGs of drawings with appliCabte�docume�sCdtlOn
<br /> Attaw 70-ta days for teview aRer submiaai date. F8rce1#-a�hh�ioetl from PropeKq F3x Notice(hitp://appraiser.pascagov.com)
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