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v,a - . .... - .... vuy too ioruy. uu.o 1 uc ran - J 10U-UULI <br /> Permit Application (v 11 <br /> Date Received 0 'p -2c-v Phone Contact for Permit Mal Ct 7$ 66'-6 <br /> Owner's Name 'I Owner's Phone Number 1 1 I I I <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number I J <br /> Fee Simple Titleholder Address I <br /> Job Address ; ; / ilica-ue,- _ 32 , .4 Ax'nCri:._ 7, ilf } . 3:71 Lot # <br /> Sub Division Parcel # I n Bio -Hazard Waste Storage - ANNUAL Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum Hood Installation <br /> I Emergency Generator < 30 kw LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL Places of Assembly- ANNUAL <br /> l 'Semi' IAN I Uther <br /> Sprinkler 11 ❑ ❑ ❑ I ( Recreational Bum <br /> Fire Alarm E ❑ ❑ ❑ I I I I Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I I I—I Sprinkler System Installations <br /> Hood Suppression ❑ Q 9Q, ❑ I I ( I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Fire Pumps I Waste Tire Storage ANNUAL <br /> Fire Works <br /> ' <br /> Flammable Application- ANNUAL I 1 Valuation of Project <br /> ' I Fuel Tanks <br /> n Other: I <br /> Contractor � / ` �Y� Co pany if- - p4.54- - Fi,, ith 0 /r-f'" ..: i <br /> Signature / RegRegistered Y / N J Fee Current I Y / N I <br /> Address I LOC7r! Oc.. 4 /-4 es _ I License # ) '74/5 - 16 - 6 , e: 'ot-G''Cfp <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N j Fee Current I Y/ N I <br /> Address ( I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # <br /> MECHANICAL Company <br /> Signature Registered Y / N I Fee Current 1 Y/ N I <br /> Address I I License # I <br /> OTHER Company <br /> Signature Registered Y/ N j Fee Current I Y/ N I <br /> Address License # <br /> Directions:_.: .. ; <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 (httpJ /appraiser.pascogov.com) <br />