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u� �-� .,..-u..�� .ny vi �cNi iy i i nuo i n c ran-o i o-i ov-vut i Permit Application Date Rece:ved � — Phone Contact for Permit �� Owner's Name �� Q � %;� � jC) Owners Phone Number �� Owner's Address Fee Simple Titleholder Name Titleholder Phone Number �� Fee Simple Titleholder Address ' S Job Address 7� O� Lot# � Sub Division Parcel # � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent Q Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL � Controlled Bum � Hood Installation � Emergency Generator < 30 kw a LP/Natural Gas-Installation � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL �y emi �n er Sprinkler � ❑ ❑ ❑ � Recreational Bum Fire Alartn � ❑ ❑ � � Sparklers Hood Cleaning �❑ ❑ ❑� a Sprinkler System Installations Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) � Fire Alartn Installation � Toroch Roofing/Tar Kettle � Fire Pumps � Waste Tire Storage ANNUAL � Fire Works � Flammable Application- ANNUAL Valuation of Project Fuel Tanks Q Other: . , . ... ..,�.. ... : - s�_ - � . ...�. . ....... �x,� _. Contractor ,� Company A 'r,( ' Signature ( �� aG�.. W Registered Y/ N Fee Current / 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 # MECHANICAL Company Signature Registered Y/ N Fee Current Y/ N Address License # OTHER Company Signature Registered Y/ N Fee Current Y/ N Address License # Directions: ' v � � ' Fili 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://appraiser.pascogov.com)