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<br /> o�o-�o�-w�u �iry oi c.e�inyrnnis rire rax-a�a-�au-uuzi
<br /> Permit A plication
<br /> Date Received . =�-Q� Q� D� f� _ Phone Contact for Permit �J� J'�Jj',� _J��
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<br /> Owner's Name L�S'2�.-� �G�,Uy'9'�N Owner s Phone Number O I� ��f�c �3��
<br /> Owner's Address ���$�� �7J p T79-�i��, �iL 33 6��t
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<br /> Fee Simple Titleholder Name Titleholder Phone Number � � �
<br /> Fee Simple Titleholder Address �
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<br /> Job Address �vL-�lV ���� `��//S '�/�;t��^ ��-��'t Lot#» f C
<br /> Sub Division Parcel#
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<br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent
<br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facllity)ANNUAL
<br /> � Controtled Burn � Hood Installation
<br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation
<br /> _ _ � Emergency Generator>30 kw_ __ _ __ _ _ _____ __�_LP/Natural_Gas-ANNUAL_Sale -- — - — - - -
<br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL
<br /> t y emi �n t er i
<br /> Sprinkler � ❑ ❑ ❑ � Recreational Burn
<br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers
<br /> Hood Cleaning � � ❑ ❑ � � Sprinkler System Installations '��`- �
<br /> Hood Suppression � ❑ � � � � Standpipes(Sprinkler Sys)
<br /> �
<br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle
<br /> a Fire Pumps � Waste Tire Storage ANNUAL
<br /> � Fire Works
<br /> � FlammableApplication-ANfIUAL Valuation of Project
<br /> � Fuel Tanks
<br /> Q Other:
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<br /> �ontractor Company f � �� �,� ��j �
<br /> iignature Registered Y/N Fee Current Y/N
<br /> Address � License#
<br /> =LECTRIClAN Company
<br /> iignature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> �LUMBER __ _ _ _ __ - Company- - — - -
<br /> iignature~ Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> AECHANICAL Company
<br /> iignature Registered Y/N Fee Current Y/N
<br /> Address License# �,
<br /> ,
<br /> )THER Company
<br /> �ignature Registered Y/N Fee Cunent Y/N
<br /> Address � License#
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<br /> )irections: _,. _ :- _ . .. • - , _, _ . _. : _ _,.__ . _ :., .�. :. . =- _- _
<br /> Fill out application complete�y.
<br /> Owner 8 Contractor sign back of application,notarized(Or,copy of sign d contract with owner)
<br /> If over$2500,a Notice of Commencement is required_(Mecha�ical wo �over$5000)
<br /> Supply two(2)sets of drawings with applicable documentation
<br /> Allow 10-14 days for review after submittal date. Parce! -obtained from Prooertv Tax Notfce(htto://aooraiser.nasr.nnnv r.nm�
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