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u �.,-, �..-���� �.ny vi �cNi ry � i uua i n c ran-o i o-i ov-wc i <br /> � Permit Application <br /> Date r<^.eived Z ( 7 2 a�� Phone Contact for Pertnit �� 3 c� t� 6 (� ct (� p <br /> Owner's Name Z�.� 5 a� # Z Owner's Phone Number �/ J� �� ��/� <br /> Owner's Address `S 6 I � ( o � �ut- <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � <br /> Fee Simple Titleholder Address <br /> Job Address �J $ '� � �SU�-- Lot # � <br /> Sub Division Paroel # <br /> a Bio-Hazard Waste Storage - ANNUAL a Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Bum � Hood Installation _ — - <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Installa6on � s <br /> � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL �, �� <br /> �y emi �n er � `7 <br /> Sprinkler � ❑ � ❑ � � Recreational Bum / � � <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ D� � Sprinkler System Installations <br /> Hood Suppression e❑ ❑ �� � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Instatiation " `\ � Torch Roofing/Tar Kettle <br /> n Fire Pumps ,�" `� � Waste Tire Storage ANNUAL <br /> u Fire Works ,� <br /> � Flammable Application- ANNUAL /� — VelUetlOfl Of P�OJ2Ct <br /> � Fuel Tanks <br /> Q Other: <br /> , � � .. .. _>. . �. . . N. . ,. - . � � . � ,, , . . .,. . . �„ ,� � . , . . . . <br /> Contractor -- Company ��.tie-F� G�f�� /n� <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address . p <J L�y p` �_ 3�e3 License# <br /> ELECTRICIAN Company <br /> Signature I Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> PLUMBER Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> MECHANICA Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> OTHER Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> Directions: � - ` - <br /> Fill out application completely <br /> Ovmer � 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 />