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313-7&0-00-0 Cil�/OfZ ephyrhi(IS FIC rex-oio-�ov-vvci <br /> Permit Applica±ion — - <br /> Dats r:�ceiv=d � � Phone Con,act for Partnit 8l ,3 Z� �5� <br /> :�:��°.F ., w�-" •„� ..<_....w�w..�_u_,.....�_..._.....�... ...�5��."� a - �� �� � ..�.�d..�., .,�-.. . �- - -_.: <br /> Own=r's Nam� ��1'�C,'. �Yl �2 l_� VI-��. ��-' Owner's Phone Number �� �� C� <br /> Own°�s Address � L 3� ��2-1LC.?F -`� �I�ki�-ts `7�?a'`� Y1' 1 lLS 2.. �J3 �}'L <br /> Fee Simple Titleholder Nams Titieholder Phone Number �� �� � <br /> ree SimpleTitlsfiolderAddress <br /> r� naraa � �m""''�.���.'��.�.s''}:�''vs ''::��";: �rs�r`"a^s�a: �"�.r':.` : . . . x�,� =-��...;�.�e,"'..f.�`°' :-`_< <br /> z: <br /> JobAddress �J' }�� 1�2.1�-(r� VI'�1.� �YC- Z!%�ik`{�LI�ILL-S Lot# � <br /> Sub Division ) t�lF Z�--.�•�l�/ 1 CLS Parcel n Z- (� • Z • l D • • Ob c� <br /> � a Bio-Hazard Wast= Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazartious Material (Tier II or RQ Faciiity) ANNUAL <br /> � Con;rotled Bum � Hood installation <br /> � Emergency Generator < 30 kw Q LPlNatural Gas-fnstallation <br /> � Emergency Generator> 30 kw a LP/Naturel Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly ANNUAL �� <br /> tr y erni Qn ar � � <br /> Sprinkler �] ❑ ❑ � � Recreational Bum 3 // <br /> Fire Alarm � 0 O ❑� � Sparkl=rs <br /> Hood Cleaning � ❑ ❑ O� � Sprinkler System fnstalfations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alarm instatlation � To�h RoofinglTar Kettle <br /> Fire Pumps � Waste Tire Storage ANNUAL <br /> Fre Works <br /> Flammable Application- ANNUAL Z�, � Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> �:.�� - <br /> Contractor Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> ELECTRICIAN Company <br /> Signature Registered Y/�l Fee Current l� / N <br /> Address l.icense # <br /> PLUMBER Company <br /> Signature Registered Y/ N Fee CuRent Y/ fV <br /> Address License # <br /> MECHANICAL Company <br /> Signature Registered Y! N Fee Current Y/ N <br /> Address Licanse # <br /> OTHcR Company �pl�� �1rLCs _��11�j..�1..5. �tilC- <br /> Signature Registered � N Fea Current / N <br /> Address Z�1 �T, '�'p'M (a. �.-• '�'3l. � License # t.�.{p � pj ZDt�Z� � 1_ <br /> ' - <br /> r x�.. ,.. ._ .�_,a.:,�.��.:.,_..., __ _ e„„ �._��, ._ _�.__ . .___._ �:.....ti._.. � .,� - - -.._.._..r�..�.�,.u.. � _����,�,� <br /> Directions: <br /> Fifl out appiication completely. <br /> Owner & Contractor sign back of application, notarzed (Or, capy of signed contrect with owrter) <br /> tf over 52500, a Notice of Commencement is required (Mechanicat woric over 55000} <br /> Suoply two (2) s=ts of drewings with appliczbie documentation <br /> Allow 10.14 days for review aft>r submittai date. Paroe! r- obtained from Property Tax No,i�e (��ttp://ap�:�iset.pascogov.com) <br />