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��., ,....-w�.. �.ny vi �cNiiyiimia � nc <br /> Permit Application rax-o i o-i ov-vvt i <br /> Date Received <br /> Phone Contact for Pertnit '� � .� <br /> Owner's Name (�,, S�� �� � �� <br /> Owners Phone Number <br /> Owner's Address 7�3 �-� � � r�� Z _ �` � /� <br /> t" <br /> Fee Simple Titleholder Name �� ^ � <br /> Fee Simple Titleholder Address Titleholder Phone Number <br /> _J <br /> ' +:4�#;'�r a.� . . <br /> Job Address � � <br /> Sub Division <br /> Lot # C� <br /> , „ Parcel # <br /> ., � , ::�. �„..:,. -..,_: <br /> � Bio-Hazard Waste Storage -ANNUAL ; - '�� " . ' ' ' <br /> � � Fumigation Tent <br /> Comm Exhaust Kitchen Hood/Duct � Hazardous Mate�al (Tier II or RQ Facility) ANNUAL <br /> � Controlled Bum <br /> � Hood Installation <br /> Emergency Generator < 30 kw � <br /> � LP/Natural Gas-Installation <br /> Emergency Generator > 30 kw a LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � <br /> Places of Assembly-ANNUAL <br /> ❑ [�f] emi � er ❑ <br /> Sprinkler � � � � <br /> � Recreational Bum ry <br /> Fire Alarm � � � �� � � � C ': <br /> ❑ Sparklers <br /> Hood Cleaning � � � � ❑ <br /> ❑ Sprinkler System installations <br /> Hood Suppression p � � ❑ <br /> � Standpipes (Sprinkler Sys) <br /> Fire Afartn Installation � <br /> (� Torch Roofinglfar Kettfe <br /> � � Fire Pumps � <br /> � Waste Tire Storage ANNUAL <br /> Fire Works <br /> a Flammable Application- ANNUAL <br /> � Fuel Tanks Vatuation of Project <br /> Q Other: <br /> ' r <br /> Contractor .. , , , , p , <br /> Signature � �� Company a �� �� <br /> Address <br /> Registered N Fee Curt,ent Y/ N <br /> ELECTRICIAN <br /> License # <br /> Signature Company <br /> Address <br /> Registered Y/ N Fee Current Y/ N <br /> License # <br /> PLUMBER <br /> Signature Company <br /> Address <br /> Registered Y/ N Fee Cument Y/ N <br /> License # <br /> MECHANICAL <br /> Signature Company <br /> Address Registered Y/ N Fee Current Y/ N <br /> OTHER <br /> License # �— <br /> Signature Company <br /> Address Registered Y/ N Fee Current Y/ N <br /> Directions: - License # � <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 dxumentation <br /> Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http://appraiser.pascogov.com) <br />