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i! <br /> s��-�so-oo20 + n e � 1 �� �� ( t;ity or �epnymms rire Fax-s��-�ao-oo2� <br /> �./��, � <br /> � _ — � � � Permit Application <br /> Date Received U � y Phone Contact for Pertnft f 3 �, l.�- �7 ir� <br /> � L�..G_L <br /> Owners Name h r � � IS I r ft U.�' - C p� 5{� �} �,,,�y„�� �ers Phone Number � f � 9' f a�3� <br /> Owner's Address ��� L�. � 0� r h r� 1 I S � L 3 3 5��.. <br /> Fee Simple Titleholder Name TiUeholder Phone Number �� ��� <br /> Fee Simple Titleholder Address - �J <br /> Job Address U (�f ' h rt� � I ls F� � � � <br /> Sub Division Lot # <br /> ��i# � �� �����o �- G �9vs c��l� <br /> a Bio-Hazard Waste Storege - ANNUAL � Fumigatlon Tent <br /> a Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Bum � Hood �nstallation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Installatiqn <br /> a Emergency Generator> 30 kw � LP/Natural Gas-ANNUAL Saie <br /> a Fre Protection MaiMenance - ANNUAL � Places of Assembly-ANNUAL <br /> � � em� � � ❑ <br /> Sprfnkler ❑ ❑ Recreational Bum / <br /> ❑ �� � /.- <br /> Fre Alerth ❑ ❑ ❑ Sparltlers �/� /� o✓ <br /> Hood Cleaning � ❑ ❑ ❑ r ❑ / ' � �'! c/ <br /> �_� Sprinkler System Installati s � I <br /> Flood Suppression �❑ ❑ O C� � Standpipes (Sprinkler S) <br /> � Fire Alartn Installation Q Torich Rooflng/Tar Kettle <br /> Fire Pumps � Waste Tire Storage ANNUAL <br /> Rre Works <br /> Flammable Application- ANNUAL „ �� <br /> Valuation of Project <br /> Fuel Tanks <br /> [] Other. <br /> Contractor <br /> Signature �) � �l, � COm <br /> Reglstered Y/ N Fee Currerrt Y/ N <br /> Address 1 d ro� �C+rQ.� � fy�;e (� Fy 3� License # <br /> ELECTRICIAN <br /> Signature � CompanY <br /> Reg�stered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> PLUMBER <br /> Signature CO � ^ �^y <br /> Registered Y/ N Fee Cument Y/ N <br /> Address <br /> l.lcense # <br /> MECHANIC <br /> Signature ��m <br /> Reg+stered Y/ N Fee current Y/ N <br /> Address <br /> license # <br /> OTHER <br /> Signature �P <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> Llcense # <br /> Directions: � <br /> RII out application completely. <br /> Owner 8 Contractor sign back of applicatlon, notarized (pr, copy o{ signed co�� ��er) <br /> tf over $2500. a Notice of Commencement is requirod (Mechanical work over $5ppp) <br /> SuPPN �(2) sets of drawings with applicaWe dxurt�errtation <br /> Allow 10-14 days for review aRer submittal date. Parcel #- obTafned from Property Tax Notice (http://appraiser.pascogov.com) <br />