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. <br /> 4 <br /> If <br /> Permit Application <br /> Date Received Phone Contact for Permit <br /> Owner's Name I Wain it /s r 1 fl-A is a 12 0 u i1 J Owner's Phone Number I 1 1 <br /> Owner's Address 1 7 i /y6 aILL &UlJ z_E/w9'R id /=C. 335 <br /> Fee Simple Titleholder Name 1 Titehoider Phone Number <br /> Fee Simple Titleholder Address 1 • <br /> Job Address 1 74' 6;44i_ &U -7 e_: y2 l /iz L s i .--:_ G - Lot # <br /> Sub Division 1 ( <br /> Q Bio- Hazard Waste Storage - ANNUAL Q Fumigation Tent <br /> Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> a Controlled Bum ED Hood Installation <br /> F - 1 Emergency Generator < 30 kw n LP/Natural Gas - Installation sa6 u LEA <br /> n Emergency Generator> 30 kw = LP/Natural Gas- ANNUAL Sale ' ice /` / <br /> 0 <br /> Fire Protection Maintenance - ANNUAL a Places of Assembly- ANNUAL <br /> other l i <br /> Sprinkler ® 0 I 1I Recreational Bum �� • } t? 'f <br /> Fire Alarm ED 0 D ❑ I I n Sparklers a ` '/ d,' / 1 4 c <br /> Hood Cleaning Ei ❑ x ❑ I 1 [] Sprinkler System Installations <br /> Hood Suppression 0 ❑ ❑ ❑ I 1 in Standpipes (Sprinkler Sys) r'r 44 moo I/ <br /> El Fire Alarm Installation n Torch Roo ing /far Kettle 4a- J) / 7( _d <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> 7 Fire Works 1-- Mrl !'cer `o✓\ <br /> Flammable Application- ANNUAL 13/s 4 I Valuation of Project <br /> Fuel Tanks ^' f b ktee <br /> r Other: I ... �.: <br /> Contractor • I Company Fes/ uF.'�oA 5 9 Stem S <br /> Signature , ...ALA, ' / , ( , (4. 1. 1 - -.A Q 'i P Registered N Fee Ct� Y / N <br /> Address " 2.c <br /> C,"QAR -[) . - e L Y. _-- �r� - • , L '_ / I - License # I <br /> ELECTRICIAN Company <br /> Signature I Registered Y/ N 1 Fee Current [ Y/ N 1 <br /> Address [ I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N 1 Fee Current 1 Y / N 1 <br /> Address I I License* [ I <br /> MECHANICAL Company <br /> signature Registered •Y / N I Fee Curent [ Y / N [ <br /> Address 1 1 License # I <br /> OTHER Company <br /> Signature Registered Y / N 1 Fee Cr Went [ Y / N I <br /> Address I License # [ <br /> csmatergeenti <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 55000) <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 : / /appraiaer.pascogov.com) <br />