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� � �-� �..-..��� �.i�y vi �cNi iyi � inia � ii c rax-o i o-i ov-vuc i <br /> Permit Application <br /> Date Received � ( Phone Contact for Permit � � �� `�� � (-�y (��( <br /> Owner's Name • y � Q' \ Cc.� Owner's Phone Number � 7� O - 7'7 { 7 <br /> Owner's Address �� J� 1��� � 1 J` J� � j�� L{ Z <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � <br /> Fee Simple Titleholder Address <br /> Job Address J q. Lot # � <br /> Sub Division Parcel # <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator < 30 kw a LPlNatural Gas-Installation <br /> � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL � <br /> �y emi �n er ` � <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum �' j� <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers � <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ �I ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alartn Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> a Flammable Application- ANNUAL Zo O Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> . . . ..: _ . , - • , ... .., . . ...,�: , . ... ... .. <br /> Contrector Company G` i`L F, ` n <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address .�. r7 �q.,� Q� 6 License # <br /> ELECTRICIAN Company <br /> Signature I Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> PLUMBER Company <br /> Signature Registered Y/ N Fce Current Y/ N <br /> Address License # <br /> MECHANICA Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> OTHER Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> Directions: " ' <br /> Fill out application completely. <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> If over $2500, a Notice of Commencement is required (Mechanical work over $5000) <br /> Supply two (2) sets of drewings with applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http://appraiser.pascogov.com) <br /> ��o�o� <br />