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�i3-iav-uu�u �,ity vi �epnyrnms rire rax <br /> Permit Application <br /> Date Rec�aved .. � �,�, e 3m, Za�� Phone Contact for Permit �� �� � <br /> Owners Name w('r+� Owners Phone Number ��� � <br /> Owner's Address s� �$ �j� �� V'� <br /> Fee Simple Titleholder Name Titleholder Phone Number �� �� <br /> Fee Simple Titteholder Address <br /> . . ;�:,:�>�:�� - , , , . _ .. , �.:. ._ <br /> °�w <br /> Job Address � <br /> Lot # <br /> Sub Division Parcel # <br /> � � . . , , . . r . .. �,�:z--y ._ ,, _ .,. . . � ., . �� .., . „ �.. .. , <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 � LP/Natural Gas-Installation <br /> � Emergency Generator > 30 kw � LPlNatural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> �y emi �n er <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ C� O� � Standpipes (Sprinkler Sys) <br /> � Fire Alartn Installation � Toroh 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 /> .. , . � �m .. .. . .. . , , � , - . <br /> Contractor ^�- Company 5 4ce �oaf'f � a .S <br /> Signature �IO.S�uA �OR(,'►^'`� Registered Y/ N Fee Current Y/ N <br /> Address 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://appraiser.pascogov.com) <br />