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From: 0$l21I2014 12:29 �903 P.001 /002
<br /> 813-7$(1-002G Clty O# �pttyfhillS FitB �ax-813-18t}-dt}21
<br /> ;. � Per it Applicatiart
<br /> Date F2eceived �� � Phone Ganiact for Permit ��
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<br /> Ovmer's Name �j Q a�,� �a����- t G�.�-Q� Chnmer s Phone Numser �1�j ��}o� 4� ��
<br /> Ovme�'s Address .J�t0�j �..,,�,i Y1 � I 1'l U.Q.. ' �� �" f /11 ��.S ��.... �J ��a.
<br /> Fee Simpie Tittehotder hiame Tit{ehotder Phone Number �� C� ��
<br /> Fee Sirnple 7iti8holder Address
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<br /> Sub Divlslon Paroel#
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<br /> � B!a-NBZacct Waste Starege-,�t,lt�tllAi. � Fumigat+on Tenf
<br /> � Comm Fachausi Kilchen HoodlDuct � Hax�rdous Materia((Tier II or RQ Facility)ANhIUAL
<br /> QCor�#rolfied 8um � Hood InstaE(ation
<br /> � Ernergency Generator c 30 kw � LP/NaWra!Gas-installation
<br />� Q Emergency�eneratar>3d kw Q �Pl�taturai�as-ANNtlA1.Sale
<br /> � Fire Protection Maintenance-ANNUAL � Plaoes of Assembly-ANNttAL. _ ��
<br /> �y ema �ri j,/�„
<br /> 3prinkier � CI C7 ❑ � RaCreationat 8um / � l�1
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<br /> Fir�Alarm � � C) CI � Sparkters �
<br /> tiood C►eaning � ❑ ❑ ❑ � Sprinklar System instatlations
<br /> Hood Suppression � ❑ [� G� � Standpipes{SprinkierSys}
<br /> � FireAlartn Instailadan � Tarch RoofinglfarKeftie
<br /> � �ire Pumps � Wsste Tire Storage ADlNUk!
<br /> � Fire Works
<br /> Q Fiammable Application-ANNUAL � � V8lU3tIOT1 Of PC4j8C1
<br /> .
<br /> � Fuet TBnkg
<br /> �] Other
<br /> . �_ . . -:- �.-�.._ �..� _.. . �.= --�.K,.--,.-.: - ...,.. :.�__. . �_ . .�..._ _,�:.�_.�. _ _. , . ., .. ... _:�_...-:�-_- -����..�-�:�,n�-._�:<,.��•.r: _,:�.:��.�,.::,.:....., �_
<br /> Contractor Company r 1...
<br /> Signature Reg�stered Y t A+f � Fea Guner�t � Y 13�1
<br /> Address License#
<br /> EG�Gi'RIGlAN Gampany
<br /> Signature Registered Y/,N Fee Current Y/NTy
<br /> Addcess Ltcense#
<br /> PLUMBER • Company
<br /> ( st�nature t�e�ist�red Y/N Fea Current Y!N
<br /> Address License#
<br /> MECHANIGAI Compas�y
<br /> Signature Registered Y/N Fee Current Y/N��
<br /> Address license�t
<br /> OTHER Cqmpany
<br /> Slgnature RegiStered Y!N Fee Current Y i f�!
<br /> Rddress License#
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<br /> �Ctirections: _ ... __ . . ..._ , . ._ . _ > ..
<br /> F:tt out apptication compieteiy.
<br /> Owner&Contractor sign back of applfcation,notarized(Or,copy ot si ned conVact with owner)
<br /> , 1€over$250D,a Naitca of Cammer�cernent!s required{Mechanicai wi k avar$5040}
<br /> Suppiy iw4(2}seis of drawings wiih appllcabte documeniaiipn
<br /> Allow 10-14 days for raviewaker submittal data. Par f#-obtalned irom F'roperty 7ax Notice(http://appraisecpascogov.com)
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