Laserfiche WebLink
ais-icsu-�u�� �,ity oi �epnyrnins rire <br /> rax-u�a-itsu-uu[� <br /> Permit Application <br /> Date Received Phone Contact for Permit �� � r <br /> I u <br /> Owner's Name Q i'J ��In � � v(Y` Owner's Phone Number C� ��� <br /> Owner's Address 7 yy� (�q l� ,�`�•d 'Z � h � n� �jS �L <br /> Fee Simple Titleholder Name '` Titleholder Phone Number C� C� �� <br /> Fee Simple Titleholder Address —J <br /> � � -::�;. �. , <br /> � . i �� :< � � '� 3.�3 Yr'�. . .`t. _ ., <br /> Job Address �� <br /> Lot # <br /> Sub Division <br /> Parcel # <br /> . . <.,. �„ .. > _ - :. :,z�.s .:� ,. �n;. W �. �.�.:. �.,.�>:.:�,a.:.:;:�; . - , . <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct a 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 <br /> a Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> ❑ �r y emi �n er ❑ <br /> Sprinkler ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning �❑ ❑ ❑�� � Sprinkler System Installations <br /> Hood Suppression � ❑ G� ❑� � Standpipes (Sprinkler Sys) <br /> � Fire Alartn Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL <br /> a Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> .� � ., . , . ... . . , <br /> � ,�. ... . . . , _. . a � :;,-.. s `.: <br /> Contractor Company � Y <br /> Signature '� ��T'`� � S ►'1�t01 kJ6 R2 ►'�^ P �oatS �' +��ite QwA ,Sa F� <br /> Registered / Fee Current Y N <br /> Address <br /> License # <br /> ELECTRICIAN <br /> Company <br /> Signature I Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> PLUMBER <br /> Signature <br /> Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> MECHANICA <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> OTHER <br /> Signature <br /> Company <br /> Registered Y/ N Fee CuRent Y/ N <br /> Address <br /> . 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 />