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<br /> o�o-�o�-w<� �ny oi �epnyrnuis r�re F8X-C'Id-ftSU-UU'L7
<br /> ` Perrnit Application
<br /> Uate FteceivAd ��� � '�Y-� �/� �� ��f" Phone Contact for Permit C� ^S � t-��J J
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<br /> Owner's Name '��� �L-V. �V� /7-7 Owner's Phone Number ,�S I�J .J ,}� /�-�
<br /> o�,�rs Aaaress �_' G7C7'�CJ��C 9'�'3� 7"f"tt�'1�"r�, �L 3�t'�c��i'`
<br /> Fee Simple Titleholder Name 7itlehoider Phone Number �� � ��
<br /> Fee Simple Titleholder Address
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<br /> �Job Address ...__ �..1� � ��'��t-%�---'V��l�L� _��>VV�..._U��� ��V�. .Lat# . ._. �
<br /> Sutr Division Parcel#
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<br /> � Bio-kSazard Waste Storage-ANPIUAI � Fumigation Tent �
<br /> Q Comm Exhaust Kitchen Hood/Duct Q Hazardous Material(Tier N or RQ Facllity)ANNUAL
<br /> � Cantrof4ed Bum o Hood installation
<br />� Q_ Eme_rgency Generator�,30 kw __________ _ _ __ _ _�Q._LF/Natural_Gas-lnstallation _— _ i.-__ _�� ---- --
<br /> I'� Q Emergency Generaior>34 kw � LPlNatura!Gas-ANNt1AL Sale �
<br />� � Fire Pratection Maintenance-ANNUAI � Places of Assembly-ANNUAL ,� `�
<br /> try em� An t er ':�
<br /> Sprinkfer � ❑ C7 E3 � � Recreationa}Bum
<br /> Fire Alarm ❑ ❑ ❑ �� � Sparklers
<br /> Hood Cleaning ❑ � ❑ � � Sprinkier System instai�ations
<br /> Hood Suppression � � ❑ O � � Standpipes{Sprinkisr Sys}
<br /> QFire Alarm Installation � Torch RoofinglTar Kettle
<br /> � �ire Pumps � Waste Tire Storage APtNUAt
<br /> � Fire Works
<br /> � Flammabfe Application-ANNUAL ���M� Valuation c�f Project
<br /> � �YIIY��I Y�ol
<br /> Fuel Tanks
<br /> Q �ther:
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<br /> �ontractor Company / tOj �c'�'
<br /> �ignature ' Registeted Y/(V Fee Gu�rent Y 1�I
<br /> Address License#
<br /> =LECTRiC1AN Company
<br /> 3ignature Registered Y/N Fee Current�`Y/N
<br /> Address License#
<br /> >LUMBER Campany �`
<br /> >ignature Registered Y I N Fee Curcent Y/N
<br /> Address license#
<br /> AECHANICAL Company
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<br /> iignature Reg3stered Y!N Fee Current Y/N
<br /> Address License#
<br /> )THER Campany
<br /> tignature Registered Y/N Fee Current Y/N
<br /> Address �icense#
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<br /> )irections:�
<br /> fiill out application campletely.
<br /> Qwner 8�Contractor sign back of appiication,notarixed(Or,copy of signed contract with owner} �
<br /> If aver$2600,a Notice of Commencement is required(Menhanical work over$5000)
<br /> Supply two(2}sets of dTawings wfih applicabls d�cumeniatlan
<br /> Allow 10-14 days for review after submittai date. Parcel#-abtained from Propertv Tax Notice/htto://aonraiser.nasmnnv r.r,r�,i
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