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<br />1l1;:S-fllll-UU,U -'-J -- --, . <br /> <br />. .1- ;; ~ B,fl Permit ApplIcation . . . <br />~~:.;~~~~_l~~'h_ :~J-...-..~__-~=""~a-~~~~j~~--1J,- -" .-. ",JJ ,.~-____..I <br />)wner's Name -::J Owner's Phone Number-I II 7~,?- II G6A>0 I <br /> <br />)wner's Address <br /> <br />=ee Simple Titleholder Name <br /> <br /> <br />=ee Simple Titleholder Address <br /> <br />TrtIehok:Ier Phone Number I <br /> <br />II <br /> <br />II <br /> <br />Bio-Hazarcl Waste Storage - ANNUAL <br />Comm Exhaust Kitchen HoodIDuct <br />Controlled Bum <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />.D~~~~ <br />Sprinkler 0 0 0 L-J <br />Fire A1ann 0 0 0 0 c=l <br />Hood Cleaning [2J 0 ~ 0 c=l <br />Hood Suppression 0 0 0 0- c=l <br />D Fire A1ann Installation <br /> <br />~ Fire Pumps <br />. Fire Works <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br />D Other: I <br />1iiii~t;~~]i~:'<ii}~~~;fSl'~.5~n--::~:~ ",-- <br />Contractor I <br />Signature <br /> <br />Address I <br /> <br />ELECTRICIAN! <br />Signature I <br /> <br />Address I <br /> <br />PLUMBER I <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br />Signature . <br /> <br />Address I <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />OTHER <br />Signature <br /> <br />Address <br /> <br />Directions: <br /> <br />I Lot# <br /> <br />-, <br /> <br />Parcel # <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />I <br /> <br />Fumigation Tent <br />Hazardous Material rner II or RQ Facility) ANNUAL <br />Hood Installation <br />LP/Natural Gas-lnstallation <br />LPINaturaI Gas-ANNUAL Sale <br />Places of Assembly-ANNUAL <br /> <br />.//' <br /> <br /> <br />g I!J~ <br /> <br />Recreational Bum <br />Sparklers <br />Sprinkler System Installations <br />Standpipes (Sprinkler Sys) <br />Torch RoofingiTar Kettle <br />Waste Tire Storage ANNUAL <br /> <br />-'\ ^~:J.- <br />L /<- of.. , v <br /> <br />Valuation of Project <br /> <br />l!\t''i~Z.;';;'':S..)!I'/~.{'_1tli~l!i~~?JIU~'-''''''''-~~!'''.';:~t~~~~i~ <br /> <br />Company <br />Registered Y/N I Fee Current I Y/N <br />License # <br />Company <br />Registered Y/N I Fee Current I Y/N <br />License # <br />Company <br />Registered Y/N I Fee Current I Y/N <br />License # <br />Company <br />Registered Y/N I Fee Current I Y/N <br />License # <br />Company 1Ji~ ~ rrt; Ph ~ I <br />Registered N Fee Current Y/N <br />License # <1 <br /> - <br /> <br /> <br />Fill out application completely. <br />Owner & Contractor sign back of application. notarized (Or. copy of signed contract with owner) <br />If over $2500. a Notice of Commencement is required (Mechanical work over $5000) <br />Supply two (2) sets of drawings with applicable documentation <br />Allow 10-14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (htIp://appraiser.pascogov.com) <br /> <br />