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��•,-.....-���� viiy vi ccNi iy i nnro i n c ran-o i o-i ou-wc i <br /> . Permit Application <br /> Dace Received �'- t� 2 O �� Phone Contact for Pertnit j3 9 p b b yb9 <br /> Owners Name Z�Q j� �p�tJ -� � Owner's Phone Number rrS/3 75'�� Oo�f/ <br /> Owner's Address � D �] �� <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � <br /> Fee Simple Titleholder Address <br /> �x�a .. ... <br /> Job Address � � � .� � ,� �t • /Z p� Lot # � <br /> Sub Division Parcel # <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent e <br /> � Comm Exhaust Kitchen HoodlDuct � Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> Controlled Bum � Hood Installation <br /> � Emergency Generator < 3� kw � LP/Naturel Gas-Installation � <br /> � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale � �, <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL �i <br /> �y emi �n er �� �� y <br /> Sprinkler � ❑ ❑ ❑ � Recreational Bum <br /> 'll <br /> Fire Alartn � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ �( � � Standpipes (Sprinkler Sys) <br /> � ( � <br /> Fire Alarm Installation �' Torch Roofing/Tar Kettle <br /> Fire Pumps � ., Waste Tire Storage ANNUAL <br /> Fire Works i f � <br /> Flammable Application- ANNUAL / / �'��� o f� — Valuation of Project <br /> 0 l� <br /> Fuel Tanks <br /> Q Other: <br /> , � . ., . , .� . • - , , , , .,. .. .. _ .,. ..,. . , ,� . .. . . <br /> Contractor � • Company 7�e, ! � (sr� <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address O Qa Lcta-�d U � La t�e 3Y� 3' License # <br /> ELECTRICIAN Company <br /> Signature � 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 /> MECHANICAL Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> OTHER <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> Directions: ' � '� � <br /> Fill out application completely <br /> Owner 8� 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 aftar submittal date. Parcel #- obtained from Property Tax Notice (http://appraiser.pascogov.com) <br />