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Fram: 08127/2014 12:29 #903 P.0011002
<br /> s�s-�aQ-oo2c City at ephychilis Fire �ax-sia-?aa-oo2t
<br /> � } Per it Applic�tion
<br /> Oate Raceive�
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<br /> Phone Gantact for ermit
<br /> Qrmer's Name ���� ��f C)+.{) ��� �� �i `�" . .Q.S Chmer s Phone Number � t�f c.�� t �f t
<br /> Owner's Address $t� 1 S 1--r��s� � �.� - r �h ► 1 I �,� 5�I2.
<br /> Fee Simpie Titiehoider M1fame Titlehoider Phone Number � � ��
<br /> Fee Sirnple 7itleholder Address
<br /> F3� ,...... ."- -- - -t:f�" _-- � - _ .�.?i;i'� — f_i: " _' _ +tii:-:=' :L�-y" _ -:�,'„ ��,:• '�.-`"'.�:?.�a�T✓�::
<br /> h��Q�-�A dress `K,�Uo�� A� .� ;JQ � n,�_�.- 11•,;��� �w ���'12t� NLU}+,l.ot# 'L�
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<br /> 5ub Divlslon PBroel�
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<br /> ,.ar'_1L->.���r..;..az.:e,±�-;,•z:r�,.'-���'•�': �:t•
<br /> � 8Eo-Fiazard Waste Starage-ANNllAt•+ Q Fumigafian Teni
<br /> � Comm Fachaust Kitchen Haod/Ouct � Harardous Materia((Tier II or RQ Facility}ANNLIAL
<br /> � Cor�tro3ted Bum � Noad Ensiailatlan
<br /> � ErnergenCy�enerator<30 kw � LPlNatara!Gas-Inslallation
<br /> Q Emsrgenay{'senet'�tar>30 kw Q �PlRtaturai Gas-ANNUAk.Sais ���,-f�
<br /> � Fire ProtecUon Meintenanca-ANNUAL � F'laces of Assembly-ANNt{AL. f� r \�
<br /> � ertt A�`T�n r �
<br /> Sprinkier Q CI C7 [7 � Racreationai Bum
<br /> Fire Alarm � O p d � SparlcleFs
<br /> fiood Cleaning � Cl ❑ O � Sprinkier System Installations
<br /> Hood Suppression � ❑ Ci G� � Standpipes(SprinklerSys}
<br /> � Fire Alarm Installation � Tarch Roc�flng/Tar Kettle
<br /> Q �ire�'umps � Wasts Tire Storage At�NUAl.
<br /> �ire Works
<br /> o Ffammable Application-ANNUAL ��_��� Valuation of Projeet
<br /> QFuet Tanks
<br /> [� Qther:
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<br /> Conlractor Company ���,��
<br /> Signature Ragfstered Y/(�E �ee Guaent Y/3�
<br /> Add�ess License#
<br /> Ei.�CTFitG�Aid Company
<br /> Signature Registered Y,/N Fee Curnent Y/N �
<br /> Address License#
<br /> pLUMBER Company
<br /> Signature Regisiereci Y/N Fee Cutrent ...._Y/[�
<br /> Address License#
<br /> MECHANICAt �ffmPas�Y
<br /> Signature Registered Y/N Fee Current Y/f'+I
<br /> Address License#
<br /> OTtiER Company
<br /> SlgrtaWre Regisfered Y/E�1 Fee Curreni Y/fV�—
<br /> Address Liaense#
<br /> �Ctirectiar�s: ... ..... . ....... .. ... _. . . ._. .,. . . . .. _.. �.. . _ _ , -. - - _ ,. _. � � _ ,...- .. ....,, �.,. .,� . - ,.. � ,._ ..
<br /> Fi1t aut apptication complete4y.
<br /> Owner&Cpntracior sign back of appl3cation,notarVed(Or,copy of ighed cantract with crwner)
<br /> tE over$2St?0,a Noftce af Commencement!s required{Nfechan�cal rk aver 55004}
<br /> Suppiy twt,(2}seis of drewings with applicabie documentation
<br /> Allow 10-14 days for review after submittal d�te. Pa ce1#-obtafned irom Property Tax Hotice(httpJ/appraiser.pascogov.com)
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