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��.,-,..�-....�.. �.iiy vi �cN�ry��nua i nc ren-oio-io�-vuci Permit Application Date Received � Z�� Phone Contact for Pertnit � Z� 6 f� � Q s�� Owner's Name /�L /� �% � ,�j Owner's Phone Number �� Owner's Address 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 Q Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL � Controlled Bum � Hood Installation � Emergency Generator < 30 kw � LP/Natural Gas-Installatlon � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale �__.-_____ � Fire Protection Maintenance - ANNUAL a Places of Assembly-ANNUAL � � emi �n er ❑ � Sprinkler ❑ ❑ Recreational Bum g � Fire Alartn � ❑ ❑ ❑ � � Sparklers I� Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installatio �` Hood Suppression � ❑ ❑ ❑� a Standpipes (Sprinkler Sys) � Fire Alarm Instaliation � Toroh Roofing/Tar Kettle � Fire Pumps � Waste Tire Storage ANNUAL � Fire Works � Flammable Application- ANNUAL Valuation of Project � Fuel Tanks Q Other: . , ' t . , _.. . ' .. _. . .ar.. �'P;:«. ., a _. .. Contractor Company Signature Registered Y/ Fee Current Y/ N Address License # ELECTRICIAN Company Signature L 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: " ' ` ` " . 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 wo�lc over $5000) Supply two (2) sets of drewings with applicable documentation Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http://appraiser.pascogov.com)