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aie-�ou-�u�u �,iry oi cepnyrrnns rire rax-ais-iau-uuzi <br /> Permit Application <br /> Date Fteceived ' �� Phone Contact for Permit 8f'o 3 6 Y7 S'�CA <br /> Owner's Name �'' � ��3 � � � <br /> Owner's Phone Number <br /> Owner's Address �fo y 3 GQ! � l.J�v D Z h� h� 1 �f FL 3�.S � 2 <br /> Fee Simple Titleholder Name Titleholder Phone Number �� C� � <br /> Fee Simple Titleholder Address <br /> . i - . , .r - • r� , .. ..�.� ,.,� . , <br /> Job Address � ` � � �' « �� Z � L �� �1 F� 3 ?,f'�( Z Lot # �� <br /> Sub Division Parcel # <br /> � Bio-HazardWasteStorage-ANNUAL � Fumigation .., x' , - F ^ Y ." ` , . <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-Instalfation <br /> � Emergency Generator > 30 kw a LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> � emi � er � <br /> Sprinkler � ❑ ❑ O Recreational Bum �f� � / •� � U <br /> Fire Alarm ❑ O ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ �� � Sprinkler System Installations � / � !' / g <br /> Hood Suppression ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation � 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 /> Contractor Company yN.t ��..c*' e3s� � . � <br /> P � <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 /> MECHANICAL Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> OTHER <br /> 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 />