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� �„-, .,�-.,�� .ny v� �cNi iy i i mro i u c rex-o i o-i ou-wc i Permit Application Date Receiveci �� Phone Contact for Pertnit �� Owner's Name �� tJ � � �1�� Owner's Phone Number � � � Owner's Address / � l��v� �✓ Z- /-�� Fee Simple Titleholder Name Titleholder Phone Number C� �� Fee Simple Titleholder Address Job Address Lot # � Sub Division Parcel # � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent b � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier 11 or RQ Facility) ANNUAL � Controlled Bum � Hood Installation � Emergency Generator < 30 kw � LPlNatural Gas-Instailation � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale Q Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL �y emi �n er Sprinkler � ❑ ❑ ❑ � � Recreational Bum Fire Alartn � ❑ ❑ � � a Sparklers Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Installations Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) � Fire Alarm Installation � Torch Roofing/Tar Kettle n Fire Pumps � Waste Tire Storage ANNUAL U Fire Works a Flammable Application- ANNUAL Valuation of Project � Fuel Tanks Q Other: Contractor � Company Y Y �� + l, , Signature �� v Registered N Fee Current Y/ N Address License # ELECTRICIAN Company Signature � Registered Y/ N Fee Current Y/ N Address License # PLUMBER Company Signature Registered Y/ N Fee Current Y/ N Address License # MECHANICA Company Signature Registered Y/ N Fee Current Y/ N Address License # OTHER Company Signature Registered Y/ N Fee Current Y/ N Address License # Directions: " Fill out application completely. Owner 8� Contractor sign back of application, notarized (Or, copy of signed contract with owner) If over $2500, a Notice of Commencement is required (Mechanical work over $5000) Supply two (2) sets of drawings with applicable documentation Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http:/lappraiser.pascogov.com)