09-9153 - Laserfiche WebLink

Browse Search

y� Permit Application Date Received I c 2 / –0 7 I Phone Contact for Permit I I I I I 4 ^ Owner's Name (✓ h2 ,', /' //1 AL,- I Owner's Phone Number 1 1 I I I Owner's Address I � � I Fee Simple Titleholder Name I Titleholder Phone Number I I Fee Simple Titleholder Address I I .ak „,WII x P2i. , 'riltn.�r �,'- Paza ,..,K.,, a � -- r-a iVATSt s „3t M.'iz' t _� °`. s1ta .u..T ..3'.�. .,.i:elt .,, '- a�.. .W.< lV,V”; .,.,..._aM. f' / .. -. ..MW _ _ < r r kin,:.,.. o �J � / / z y,/ u Job Address !i 3O J5 /..c" J O' � fJAi i– / "/S -. 3335? !2 Lot # I Sub Division I Pa .. __... �..3 ..c._..,.lm_. a. iGU_ L... &:,v.2..u.l- s..eAav . ,M ,... ., a __.._. .,._..a ............. a ...:n... ........:12..,... . u = Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent I Comm Exhaust Kitchen Hood/Duct 0 Hazardous Material (Tier II or RQ Facility) ANNUAL - / / „ if Installation • � ( Hood Controlled Burn 0 0 Emergency Generator < 30 kw n LP /Natural Gas - Installation l 7 Emergency Generator > 30 kw LP /Natural Gas - ANNUAL Sale / q El Fire Protection Maintenance - ANNUAL n Places of Assembly - ANNUAL (I 1 ry emi Other f�-i Sprinkler E g ❑ ❑ I] Recreational Bum Fire Alarm El ❑ 151 ❑ I I n Sparklers Hood Cleaning 0 ❑ ❑ ❑ 1 1 n Sprinkler System Installations Hood Suppression E ❑ ❑ ❑ I I [ ] Standpipes (Sprinkler Sys) El Fire Alarm Installation n Torch Roofing/Tar Kettle El Fire Pumps n Waste Tire Storage ANNUAL R Fire Works Flammable Application - ANNUAL f I Valuation of Project 0 Fuel Tanks n Other: I I ,.H:..:i5_....y ,': .aw ,`:=' ,_y,xii'xtm. xct . w . tt.4 ... 4.wgw4"'`c":. Contractor Company ��% ,�e/jI.gIMII Signature w _ Registered Y / N Fee Current Y / N Address I License # I ELECTRICIAN Company I Signature Registered Y/ N 1 Fee Current I Y/ N 1 Address I I License # I PLUMBER Company I Signature Registered Y / N I Fee Current I Y / N 1 Address I I License # I MECHANICAL Company I Signature Registered Y/ N I Fee Current I Y/ N 1 Address I I License # I OTHER Company I Signature Registered Y/ N 1 Fee Current I Y/ N Address I 1 License # I I Directions: Fill out application completely. Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) If over $2500, a Notice of Commencement is required (Mechanical work over $5000) Supply two (2) sets of drawings with applicable documentation Allow 10 -14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com)