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a. I .... ......... ,-.. viay tat Lct, oyo nu10 1 u_c, A 1 i,,./ raw - IJ raU -UUL t <br /> Permit Application fl 'i , - <br /> DateReceived `j Phone Contact for Permit Mal Z e . 7(5' <br /> 66-6 <br /> Owners Name L O wners Phone Number ) <br /> 1 1 1 <br /> Owners Address <br /> Fee Simple Titleholder Name Titleholder Phone Number I I [ <br /> Fee Simple Titleholder Address I <br /> Job Address A-6 5 dL ,5 - 9 0 6. 7- 4 /d 6.4 // 0/V . �C�/l yl , _ Lot # <br /> l <br /> Sub Division Parcel # <br /> ,,r,.s.:f- , „,, r .: r , ,..,.....„ --,. ,. - rx ,y r � „,,, ,- :,... ,,- . -2- , : .;?o -sr -.s ? —ice -. rentr : F�- ° -.-c�' .. .. ... <br /> I I Bio -Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum I I Hood Installation <br /> I I Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> I I Emergency Generator > 30 kw I 1 LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL <br /> Iutriyl ISemtj (AnT1 Other <br /> Sprinkler n ❑ ❑ ❑ I I Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I I I Sparklers <br /> Hood Cleaning I 1 ❑ ❑ ❑ I I ( I Sprinkler System Installations <br /> Hood Suppression 12r ❑ �Q, ❑ ( 1 1 1 Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation Q ( I Torch Roofing/Tar Kettle <br /> El Fire Pumps I I Waste Tire Storage ANNUAL <br /> I I Fire Works <br /> Flammable Application- ANNUAL 1 1 Valuation of Project <br /> Fuel Tanks <br /> ri Other: 1 <br /> Contractor ..-7.-) / T :+ Company mee, - p/54- - p, i� f: i.„... 4 1-r ( <br /> Signature / Registered Y/ N 1 Fee Current I Y/ N I <br /> Address y7c( PG-4_ P�.r C 6 tom. -7 _ t t I License # '7/45 CV, of -G'C>(p 1 <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N J Fee Current I Y/ N J <br /> Address ( I License # I <br /> PLUMBER Company J <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 J Fee Current 1 Y / N I I <br /> Address ( I License # I <br /> OTHER. Company <br /> Signature Registered Y/ N I Fee Current I Y/ N J <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 (httpi /appraiser.pascogov.com) <br />