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37.2 42.96 m 37.2 771.6 l 575.28 771.6 l 575.28 42.96 l h W n q 37.2 42.96 538.08 728.64 re W n BT /CS0 cs 0 0 0 scn /TT3 1 Tf 10.08 0 0 10.08 61.92 323.7601 Tm (4) Tj ET Q Q q 37.2 42.96 m 37.2 771.6 l 575.28 771.6 l 575.28 42.96 l h W n q 37.2 42.96 538.08 728.64 re W n BT /CS0 cs 0 0 0 scn /TT3 1 Tf 10.08 0 0 10.08 61.92 302.8801 Tm (5) Tj ET Q Q q 37.2 42.96 m 37.2 771.6 l 575.28 771.6 l 575.28 42.96 l h W n q 37.2 42.96 538.08 728.64 re W n BT /CS0 cs 0 0 0 scn /TT3 1 Tf 10.08 0 0 10.08 61.92 234.0001 Tm (1) Tj ET Q Q q 37.2 42.96 m 37.2 771.6 l 575.28 771.6 l 575.28 42.96 l h W n q 37.2 42.96 538.08 728.64 re W n BT /CS0 cs 0 0 0 scn /TT3 1 Tf 10.08 0 0 10.08 61.92 213.1201 Tm (3) Tj ET Q Q q 37.2 42.96 m 37.2 771.6 l 575.28 771.6 l 575.28 42.96 l h W n q 37.2 42.96 538.08 728.64 re W n BT /CS0 cs 0 0 0 scn /TT3 1 Tf 10.08 0 0 10.08 61.92 180.2401 Tm (1) Tj ET Q Q q 37.2 42.96 m 37.2 771.6 l 575.28 771.6 l 575.28 42.96 l h W n q 37.2 42.96 538.08 728.64 re W n BT /CS0 cs 0 0 0 scn /TT3 1 Tf 10.08 0 0 10.08 61.92 160.3201 Tm (3) Tj ET Q Q q 38.16 131.76 536.64 11.76 re W n BT /CS0 cs 0 0 0 scn /TT2 1 Tf 9.12 0 0 9.12 39.6 135.6001 Tm ( I have read and understand ) Tj 0.867 0.031 0.024 scn /TT4 1 Tf 13.861 0 Td (THE REVERSE SIDE) Tj ET 165.6 134.16 87.84 0.24 re f BT 0 0 0 scn /TT5 1 Tf 9.12 0 0 9.12 254.1916 135.6001 Tm ( ) Tj /TT2 1 Tf 0.28 0 Td (of this permit and agree to abide by the requirements) Tj ET Q q 37.2 42.96 538.08 728.64 re W n BT /CS0 cs 0 0 0 scn /TT2 1 Tf 10.08 0 0 10.08 61.44 96.2401 Tm (E) Tj 9.12 0 0 9.12 106.8 60.4801 Tm (Print Name) Tj 22.5 0 Td (Signature) Tj 13.605 0 Td ( Date) Tj ET Q q 310.08 473.52 248.16 19.92 re W n BT /CS0 cs 0 0 0 scn /TT3 1 Tf 10.08 0 0 10.08 312 475.9201 Tm (4\056 Cell Phone Number\072) Tj ET Q q 74.88 460.56 110.16 12 re W n BT /CS0 cs 0 0 0 scn /TT2 1 Tf 10.08 0 0 10.08 76.8 462.9601 Tm [ (W) 18 (eldor \050s\051 Info\056\072) ] TJ ET Q q 74.88 631.68 483.36 20.88 re W n BT /CS0 cs 0 0 0 scn /TT3 1 Tf 10.08 0 0 10.08 76.8 638.6401 Tm (Project Coordinator\047s Name\072) Tj ET Q q 74.88 536.16 110.16 12 re W n BT /CS0 cs 0 0 0 scn /TT2 1 Tf 10.08 0 0 10.08 76.8 538.5601 Tm (Internal Requestor\072) Tj ET Q q 74.88 377.04 483.36 19.92 re W n BT /CS0 cs 0 0 0 scn /TT3 1 Tf 10.08 0 0 10.08 76.8 379.4401 Tm [ (Name of Person Performing W) 18 (elding\072) ] TJ ET Q q 74.88 342.24 235.2 20.88 re W n BT /CS0 cs 0 0 0 scn /TT3 1 Tf 10.08 0 0 10.08 76.8 344.6401 Tm (Building Name\072) Tj ET Q q 310.08 342.24 102 20.88 re W n BT /CS0 cs 0 0 0 scn /TT3 1 Tf 10.08 0 0 10.08 312 344.6401 Tm (2\056 Floor Number\072) Tj ET Q q 412.08 342.24 146.16 20.88 re W n BT /CS0 cs 0 0 0 scn /TT3 1 Tf 10.08 0 0 10.08 414 344.6401 Tm (3\056 Room Number\072) Tj ET Q q 74.88 364.08 110.16 12 re W n BT /CS0 cs 0 0 0 scn /TT2 1 Tf 9.12 0 0 9.12 76.8 366.4801 Tm [ (W) 18 (orksite Information\072) ] TJ ET Q q 74.88 438.72 483.36 20.88 re W n BT /CS0 cs 0 0 0 scn /TT3 1 Tf 10.08 0 0 10.08 76.8 441.1201 Tm [ (Name of Person 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(TCH ) ] TJ /TT5 1 Tf 6.391 0 Td (COMPLETED) Tj ET Q q 53.76 264.48 504.48 36 re W n BT /CS0 cs 0 0 0 scn /TT4 1 Tf 10.08 0 0 10.08 55.68 266.8801 Tm [ (THIS FORM SHALL) 18 ( BE KEPT ON JOB SITE \046 ) ] TJ ET 55.68 265.44 220.32 0.24 re f BT 0.867 0.031 0.024 scn /TT4 1 Tf 7.92 0 0 7.92 276.1505 266.8801 Tm [ (Returned to Kean Fire Safety Of) 18 (fice Upon Completion) ] TJ -0.0002 Tc 10.08 0 0 10.08 477.5458 266.8801 Tm ( ) Tj ET 276.24 265.44 212.4 0.24 re f Q q 53.76 252.48 504.48 12 re W n BT /CS0 cs 0 0 0 scn /TT2 1 Tf 9.12 0 0 9.12 222.96 254.8801 Tm [ ( ST) 74 (ART UP) 18 ( TIME ) 37 (AND DA) 74 (TES) ] TJ ET Q q 53.76 666.48 504.48 12 re W n BT /CS0 cs 0 0 0 scn /TT2 1 Tf 10.08 0 0 10.08 55.68 668.8801 Tm [ (I\056 Requestor Completes Section ) 37 (A) 37 ( or B and C\054 D \046 E and ) ] TJ 0.867 0.031 0.024 scn (must read reverse side ) Tj 0 0 0 scn 38.047 0 Td (of document\072) Tj ET Q q 74.88 321.36 111.12 20.88 re W n BT /CS0 cs 0 0 0 scn /TT3 1 Tf 10.08 0 0 10.08 76.8 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