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�� .............<� �.��y vi �cNiiyiinna i nc ran-oio-iov-wti <br /> Permit Application <br /> Date Receiv��d Phone Contact for Pertnit �� ��G. � <br /> Owner's Name {'7 Z�cT � ( Owner's Phone Number ��3 77 �° (�,� <br /> Owner'sAddress �� (j �� c� —(.��( �� . <br /> Fee Simple Titleholder Name Titleholder Phone Number �� �� <br /> Fee Simple Titleholder Address <br /> Job Address � <br /> Lot # <br /> Sub Division Parcel # <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct a Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum � Hood Installation <br /> � Emergency Generator < 30 kw Q LP/Natural Gas-Installation <br /> � Emergency Generator> 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> � emi � er <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum <br /> Fire Alarm � ❑ ❑ F7 � � Sparklers <br /> Hood Cleaning ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑� a Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation � Toroh Roofing/Tar Kettle <br /> Q Fire Pumps � Waste Tire Storege ANNUAL <br /> a Fire Works <br /> � Flammable Application- ANNUAL r--� Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> Contractor ✓� Company j� + . ' !'�'f .„,,' ' . M. . , ` <br /> Signature t�(/ � Registered N Fee Current Y/ N <br /> Address 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 /> MECHANICA Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> 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 /> Ovmer 8 Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> If over $2500, a NoUce of Commencement is required (Mechanical woric 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 />