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u ie-�au-vu�u �.i[y oi cepnyrnws rire rax-u�s-iuu-uuz� <br /> Permit Appiication <br /> Received Phone Contact for Permit ��� <br /> , _ . .. :.� � :- . .. <br /> Owner's N�ne . e Owners Phone Number �� � <br /> Owner's Address �. ( 1� <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � <br /> Fee Simple Titleholder Address <br /> ..., ' - 3� :, x5 � �«.�."v'�L•_�;a(��:✓"'i 334��.'--�'�iR - :'��S s"'!Vm$`�:"'.�R$�;,G,: �.$.+05� » - �#:.i ,e <br /> Job Address ' Lot # � <br /> Sub Division Parcel # <br /> . .. � � ,..>:'r:z:. ,,. .. ���::"'Za...u=::»;s"�?... c.... .... z: . ,. � .,..b...a>.:k.';.: _,.> ' a .�, e..... , , . .. � <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm F�chaust 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 � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> �y emi �n er , y� <br /> Sprinkler � ❑ ❑ ❑ � Recreational Bum ��p� j Z � � <br /> Fire Alartn � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> a 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 /> ,.. . ,;-,. � _ . .. ,- . . - , ., • . -. , .. <br /> Contractor Compa�y <br /> Signature �� Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N Fee Curtent 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 8 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 />