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uia-iou-uu�u �.izy oi �epnymuis rire rax <br /> Permit Application <br /> Date �eceivec', — S� J�' � Phone Contact for Pertnit 8/3 8� �45� <br /> Owner's Name r � Ow�er�s Phone Number �,3 �� �/�� 1 <br /> Owner's Address �g � <br /> Fee Simple Titleholder Name Titleholder Phone Number C� C� �� <br /> Fee Simple Titleholder Address <br /> w::. � ,:<:z., , - , ,a ::��..n�,�.�..,_ <br /> Job Address Lot # �� <br /> Sub Division Parcel # <br /> ' . ...�,a• .. . .�-, ,....,. — � <br /> � .� -• - . :..,. .... ..>, ;._:.:: � .... . . .. ;=�y.:: :� : w � <c._. . <br /> Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier il or RQ Facility) ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Installation /--- <br /> � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale _ j /�p ' Z�� <br /> � Fire Protection Maintenance - ANNUAL Places of Assembly-ANNUAL �]- � <br /> ❑ �y emi �n er ❑ � � <br /> Sprinkler ❑ ❑ ❑ Recreational Bum <br /> Fire Alartn � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑�� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alartn Installation � Torch Roofinglfar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> . , . , .� .>�t.. 7xr-}�... <:f` � k'°.i��s�;.�y; , . _. � �• , - � . .c,��... , <br /> Contractor .. .,.. : � �r �; � 4v •:..� : . .. . ..._, ,. <br /> /)/'✓J �.�J �0 Company <br /> Signature '// �/� Registered Y/ N Fee Current Y/ N <br /> Address 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 Fee 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 drawings with applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http://appraiser.pascogov.com) <br />