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ui�-rau-uu�u t.iry oi cepnyrnnis rire rax-uie-iau-uuzi <br /> Permit Application <br /> �.G _��_ � � Phone Contact for Permit �� � C� <br /> Date Re � �ver3"` .. . <br /> Owner's Name - L + if «C' Owners Phone Number O � �7 � �-S <br /> Owner's Address �p C1 a �'�'� ��� S ` L- 3 <br /> Fee Simple Titleholder Name Titleholder Phone Number �� C� <br /> Fee Simple Titleholder Address <br /> - .�...,�_, - � � A .�w:�;r,.s:�� � . . 3. <br /> Job Address Lot # �� <br /> Sub Division Parcel # <br /> .� ;::F ... ... . , :�� �<�... .., .. ..�..... .. .: _ , , - . .. -. . ., r.�:<.�x�. �:r. . . ,. ..�;. . <br /> � Bio-Hazard Waste Storage -�ANNUAL a 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 � LP/Natural Gas-Installation <br /> � Emergency Ge�erator> 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL o�Pfaces of Assembly-ANNUAL <br /> � emi � er <br /> Sprinkler � ❑ ❑ ❑ � Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers � <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation a Torch Roofing/Tar 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 /> .. .. • , .>,.> - .. � . . . < , : . . .. - . .. ,. �, . , .. � �,.. . . , <br /> Contractor ,� Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address '�j ,3 � ' (� u �� Z )15 �� 3 S J License # <br /> ELECTRICIAN Company <br /> Signature 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 /> MECHANICAL 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:/lappraiser.pascogov.com) <br />