Laserfiche WebLink
08/02/2002 10:58 2094633 FIFTH FLOOR PACS 02 <br />06/27I2001 13:57 2094683433 FIFTH FL£H]R R�Pi3���D <br />A4MWX ..=Mf VOR WE86 dU= V= ;=AOFIT, OR PI2rUG RHPAIR PERMIT <br />T=5 PERPSYT tXPIRES. 40 DAYS FROM W&E APPROVAL AAT&. 4D D= mz= AZCd SztvYCa rep.MST ^YPE JU 2 s7 �ofl2 <br />.,«�eaxx nxsIT _ pxPs +Ars <br />SPA SITS ¢ FRAT•CT cor*= & q. <br />F <br />saCzzrrt Nam t11 K$ f NAP -V -e (� •�''i rnoete m 2 p�j % 8° -1.13 <br />C 1 X 0, 0 S. 0 L/ V E AVE.$?CeA • q��D$ <br />Z <br />T OWNERIOVZRA-ZORG?U f 57 P HAk4Gr'-.5 , NC, , } SOD) oz3 -.�72 r <br />7'R/AA&t6�Gy� t+'/20�1d1�i9•.!7?�L, PH== l�' 8 74.2p <br />ON LO=Ac= ADDRESS ���� � ��B��� �LVlJ. 1 CA LIC 3 j CLASS [ <br />R68i2�i <br />A <br />C O= S=RMA?SOK I <br />T <br />i pg= x <br />----i$itltil#$3133[11$(#1$I1ltiiil <br />•tan7& };D 5 TANK SIZE CMtMICa45 STOR£O CD'LX/8R517S0USLY 11AA71: 052' I"r.STTL'.ED 1 <br />z$ �9• 3 f i I <br />P i <br />31- <br />I fill 111] 111111 liiiiiiiiiiiiiiii,[ <br />9-i[itl111]111111$iiiiiiliiiiiiiii,i It tt iil It E1Eitil$Eii#Itl i t i liitliil3$liI[E # 11[ Ilii-[ [1� 131111[3 <br />�,, � APP AP7� �D pni�7 ^ONtS; D:S.7PErZOV'aG <br />A l f5£° A a kT'rH OMS) I <br />N 1 BLAH P�fTRWERS NAML B%+•I.•:. <br />—ililtlllIi111111I1i1E111i 111E I liifl i i! i 333$1 t#Ii 111111111111111 [I11i11li I li Ei i$tltill[i�itl'1!1 I <br />,APPLSCANT MOST PERFORM ALL 'AM 1W ACCORD-?rC£ VI^R $-t$ .TQ;k0 1W C6tWvrY STATE :AUS. %XM RW -E$ jUMM 2=U7.ATZQNS DF <br />S:.tt SO.ADCtIN C [wry ?UaLTC H=-179 S:MccGs _ Q:i rZR OR LICENSED AGSNT' S SIG.'QT.TGRE CURTIFIBS THE POLS.O"dIXG; •Y CaR=F: TRk _4 [ <br />Tbs F=KW4Wfq,-, OF .Xr WGRX VOR %WCff ?SSS P-ORM7T IS ISSEMb• Srar•L KOT E MEW. Aar% PERSON IN SUCH A -X%NNCR AS , 0 3=QKZ j <br />SL'9.7E't^ TO WORIMIS COu7fNSaTI04r Lxvs OF Cu.=1FQ2VZ 1. C r1'aAL,'1'a1t,5 LT.;= aR Stmc6 r,--AcT2tz ai--,m-u22 G^T,'IFISS TdI <br />„ CCR2'SFY TS, -T i.V THE vv2PORMT,NCE OF T?3£ WORK FCR WRICH THIS PzRMIT IS Z5513=5 . I SHALL EMPLOY PRSOaS Sv�T'CT TO <br />COXP WSATIOM LAYS Of C 1LTF4gN3:A- a ��-- ,,}}•�-••[ <br />A?PLSCA$"r'S S:CSA' T=- ��l/�J TW= �/C >l��X� +- aATG `j/S--fi.1- <br />1 <br />BILLING XWFO RATION. <br />Tadicate the responsible part) to be billed for additional PES -Em staff tine expender bey :` <br />permit payment coverage per tauk. If the party designated below is different than pe -m -'t <br />applicant, e.g. prope=ty owner, she party m st acknowledge this responsi_b--1 ty for the <br />by signature and date below, <br />7T1.Qtil&-tZ .? Zar YJ BUR13AA14 RLVb. `D,�,, <br />Name �1VI2f plME�1774G adc1ress�L P-15A1tkCA . phone number�2;W) 70-7010 <br />Sig-,.atu�e f <br />23-0038 D I CCC I DD 1) U8 k-1 e 7c{J <br />JUI� 2 3 2002 <br />(��qk'4b ,.qqS a— <br />ENV1ROWENT HEALTH <br />PERMIT/Sr -7 Z� <br />lel � <br />