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v •- ••••• -••••' viiy v. L.cN..y. nu.o . ua ( P , ^ 7,4' V.7, lJ - ( U <br /> ... i Permit Application_ <br /> Date Received V - 19-i - 1CX Phone Contact for Permit <br /> Owner's Name I Owners Phone Number <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> 1 1 <br /> Fee Simple Titleholder Address I <br /> Job Address WC // 5prr r j Al ` - - 37515" /51- 4 e- i ? r. Lot # I:. <br /> Sub Division ( J Parcel # <br /> I I Bio -Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct I I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I Controlled Bum I I Hood Installation <br /> I —I Emergency Generator < 30 kw I LP /Natural Gas- Installation <br /> I I Emergency Generator > 30 kw I I LP /Natural Gas- ANNUAL Sale <br /> I Fire Protection Maintenance - ANNUAL I - I Places of Assembly- ANNUAL <br /> It.ttriy) lSemiI IAN I Other <br /> Sprinkler I I ❑ ❑ ❑ I I Recreational Bum <br /> Fire Alarm I I ❑ ❑ ❑ I I I 1 Sparklers <br /> Hood Cleaning I ! ❑ ❑ ❑ I I I 1 Sprinkler System Installations <br /> Hood Suppression ❑ (j` S. ❑ I 1 .I I Standpipes (Sprinkler Sys) <br /> I - I Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> I Fire Pumps I I Waste Tire Storage ANNUAL <br /> I - I Fire Works <br /> I Flammable Application- ANNUAL I I Valuation of Project <br /> I I � Fuel Tanks <br /> fI Other: I <br /> Contractor l ), OW Company Mae- - p - p, <br /> Signature Registered Y / N . 1 Fee Current I �Y � �� <br /> 1 - 17 !ic. / �5lY�- -T _ 1 License # I <br /> Address <br /> I '7�s /fry e�do���� 1 <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N j Fee Current I Y / N <br /> Address I I License # I <br /> PLUMBER Company - I <br /> Signature Registered Y / N . 1 Fee Current I Y / N <br /> Address I <br /> I License # <br /> I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N j Fee Current I Y' / N I 1 <br /> Address ( I License # I I <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N j <br /> Address <br /> 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 />