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s��-�so-oozo c:iry or cepnym�us r�re FaX-a��-�ao-ooz� <br /> Permit Application <br /> Date Received = Phone Contact for Pertnit � r� � <br /> t=` <br /> Owners Name i Owners Phone Number p� 3 � (P � <br /> Owner's Address (p 3 ( �,t° �'�,� t v �� <br /> Fee Simple Tftleholder Name TiUeholder Phone Number ��� <br /> Fee Simple TiGaholder Address <br /> Job Address �O �J,�� (� V C�. . � rh i 1 I 5 �,l.._ 3�� o� Lot # � <br /> Sub Division p # <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigatlon Tent <br /> � Comm Exhaust Kitchen Hood/Duct a Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlied Bum � Hood Installatlon <br /> � Emergency Generator < 3p � a LPMatural Gas-Installation <br /> � Emergency Generator> 30 kw � LPMatural Gas-ANNUAL Sale <br /> a Fire Protection Maintenance - ANNUAL a Places of Assembly-ANNUAL <br /> � mi (AnT� r <br /> Sprinkler � ❑ p � � � ��tional Bum � <br /> Fire Alarm � ❑ O ❑ � � Sparklers �� <br /> Hood Cleaning ❑ ❑ � S rinkler I � <br /> ❑ � � p System Installations <br /> Nood Suppression �❑ ❑ ❑� a Standpipes (Sprinkler Sys) <br /> a Fire Alartn Installation � Torch RoofinglTar Ketde <br /> Fire Pumps � Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application-ANNUAL o[,�� Valuation of Project <br /> Fuel Tanks <br /> 0 on,er <br /> Contractor Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address t D`�Y� ' t0 �, License # <br /> ELECTRICIAN � <br /> Signature � Registered Y/ N Fee Cument Y/ N <br /> Address License # <br /> PLUMBER �� <br /> Signature Registered Y/ N Fee Curtant Y/ N <br /> Address Llcense # <br /> MECHANIC ��� <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address ����� # <br /> OTHER � <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> Directions: <br /> Ffll out appNcation completely. <br /> Owner & Contractor sign back of applicatlon, notarized (Or, copy of signed contract with owner) <br /> If over $2500, a Notice of CommencemeM is roquirnd (Mechanical work over $5000) <br /> Supply two (2) sets of drawings with applicable dxumet�tation <br /> Allow 10-14 days for review after submittal date. Parc:el #- obtained from Properly Tax Notice (httpJ/appraiser.pascogov.com) <br />