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• ••..,a fit inpplIVCILIU11 <br /> late Received • - Phone Contact for Permit <br /> rnmers Name A ! , th `k- /s �-CN 47 a 7, h L; , 1 Owner's ' Ph ' one Number ��� 12 �� t <br /> • <br /> owners Address I 3 i E3 0 No e- Ze pkir Vi + t 1'S ■ 1 1 3 3 6 y . )-.. =ee Simple Titleholder Name 1 1i Titleholder Phone Number <br /> ;es Simple Titleholder Address <br /> Job Address • a a V ty ` C ♦ :_ l / 115 Lot # <br /> Sub Division <br /> 1 ( o "v ®/ <br /> 1 <br /> Parcel # <br /> l� \a�� <br /> .. ter. _ .. . <br /> n Bio-Hazard Waste Storage - ANNUAL ED Fumigation Tent <br /> ED Comm Exhaust Kitchen Hood/Duct I Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> n Controlled Bum a Hood Installation �f I, 0 <br /> I — 1 Emergency Generator < 30 kw h LP /Natural Gas - Installation i V /tl' <br /> f Emergency Generator> 30 kw LP /Natural Gas - ANNUAL Sale V <br /> Fire Protection Maintenance - ANNUAL In Places of Assembly- ANNUAL <br /> �;, — raj tither <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum / 0 Fire Alarm ❑ ❑ I I E Sparklers <br /> Hood Cleaning ❑ ❑ / ❑ - I I I I Sprinkler System installations <br /> Hood Suppression CI ❑ ❑ ❑ I I Ii Standpipes (Sprinkler Sys) <br /> a Fire Alarm Installation ED Torch_Roofing!Tar Kettle <br /> Fire Pumps I Waste Tire Storage ANNUAL <br /> Fire Works ' <br /> Flammable Application- ANNUAL I Valuation of Project <br /> Fuel Tanks <br /> ❑ Other <br /> _., <br /> Contractor � Company 1 " � . Jn IC. �'� 5 t-K'te. <br /> .0- , <br /> Signature Re �� N Fee Current MEI <br /> Address 1'r.7gTi. 1 R! , t alin yonlairgn License # F P l 0Q6 (0 L I <br /> ELECTRICIAN Company <br /> Signature Registered Y / N Fee Current Y / N ` <br /> Address I License # I I <br /> PLUMBER l Company <br /> Signature Registered Y / N Fee Cu rre nt Y/ N <br /> Address I License # f <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current ` Y/ N l <br /> Address I I License # I <br /> OTHER Company <br /> Signature Registered Y / N Fee Curr Y / N <br /> Address I ( License # <br /> License , .. .......-licreastintr <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 (http: / /appraiser.pascogov.com) <br /> . <br /> I <br />