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<br />Owner's Name <br /> <br />Owner's Address <br /> <br />Fee Simple Titleholder Name <br /> <br />Job Address <br /> <br />Sub Division <br />E_.ml\_~iilJ'!P'l~- <br /> <br />~! <br /> <br />D <br />D <br />D <br />D <br />o <br />D <br /> <br />l! ]1 <br /> <br />Ft~rr <br /> <br />J.i.ifl <br /> <br />1TI'l:l"'~~'fu. <br /> <br />'M1II1l!$illilliX <br /> <br />Bio-Hazard Waste Storage -ANNUAL <br />Comm Exhaust Kitchen Hood/Duct <br />Controlled Bum <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />. ~~~~ <br />Sprinkler D 0 0 0 L-l <br />Fire Alarm D 0 0 0 c=J <br />Hood Cleaning 0" 0 d 0 c=J <br />Hood Suppression D 0 0 0 c=J <br /> <br />Fire Alarm Installation <br /> <br />Fire Pumps <br /> <br />Fire Works <br /> <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br />D <br />D <br />D <br />o <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />Fumigation Tent <br />Hazardous Material (Tier II or RQ Facility) ~1NUAL } <br /> <br />Hood Installation ~' GIG,' 1- <br />LP/Natural Gas-Installation /) { <br />LP/Natural Gas-ANNUAL Sale <br /> <br />r!}? <br /> <br />L./' A J! f- /) 'LA-C <br />d- eJ' ...--o( <br />rl/ (f <br /> <br />-w- <br /> <br />Recreational Bum <br /> <br />Places of Assembly-ANNUAL <br /> <br /> <br />Sparklers <br /> <br />Sprinkler System Installations <br /> <br />Standpipes (Sprinkler Sys) <br /> <br />Torch Roofingrrar Kettle <br />Waste Tire Storage ANNUAL <br /> <br />Valuation of Project <br /> <br />Rr;P <br /> <br />iIlWJI "" <br /> <br />Other: <br /> <br />Contractor <br />Signature <br /> <br />Address I <br /> <br />ELECT. RICIANI <br />Signature . <br /> <br />Address I <br /> <br />PLUMBER <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br />Signature , <br /> <br />Address I <br /> <br />OTHER <br />Signature <br /> <br />~d~ess L",.~~~~ ,"' <br /> <br />Directions: <br /> <br />- .ll~" <br /> Company <br /> Registered <br /> License # <br /> Company <br /> Registered <br /> License # <br /> Company <br /> Registered <br /> License # <br /> Company <br /> Registered <br /> License # <br /> Company <br /> Registered <br />,""","~.Jj License # <br />- <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br />- _'" ... '1!IIlImI" <br /> <br />'i"'f~"W~SliItfi~,.".h <br /> <br />~~.~ , ..,~v_"" <br /> <br />RiI-~~.J:.c[m - <br /> <br />I <br /> <br />liJ ~~j"1Wl'l <br /> <br />I <br /> <br />lIA//~~SE ~V/~! <br />Y I N Fee Current Y I N <br /> <br />I <br /> <br />I <br />I <br /> <br />I Y IN <br />I <br /> <br />I Y IN <br />I <br /> <br />I Y/N <br />I <br /> <br />I Y/N <br />I <br />~ilIIl:w~~'r)l(rrTJ r~ N'if ~ <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <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 (htlp:/lappraiser,pascogov.com) <br />