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nia-�ou-uu�u �,ity oi cepnyrnms rire rax <br /> Perrnit Application <br /> Date Received Phone Contact for Permit ���� <br /> Owners Name '�� Owners Phone Number �� <br /> Owner's Address (� v �}'� � �(LS '� �j 3 S l- � Z <br /> Fee Simple Titleholder Name Titleholder Phone Number �� �� <br /> Fee Simple Titleholder Address <br /> ,. "° .r• :ws; .5��°�.w;'°Fk"°:';z=!.r'x�> ' - '�t�l'r,- r;�a�..:°�;�"�A�� '-5e.��: - , . . <br /> ;�s .� <br /> Job Address � <br /> Lot # <br /> Sub Division Parcel # <br /> . . , _ .w , � Y. :. -..�. ; :=s: «.A�:�� ,�... . .,�:� k:,3.�M. « ..: , _ .. - . . . ., a'�. aw;es <i r„ -t . _. �.._ ... ...... . i , . <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-Instaltation <br /> Emergency Generator > 30 kw LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintena�ce - ANNUAL Places of Assembly-ANNUAL <br /> ❑ �y emi �n er <br /> Sprinkler ❑ ❑ O Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofingffar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammabte Application- ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> � � <br /> „�.i=, „v+" - r- , a� ... _�.-,, . ._s�e. . ., ., . „ � .:;x . .. ��, .. .. , r <br /> , .. . . ;�°,. . . �. <br /> Contractor Company <br /> Signature � �� 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 Curtent 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 NoGce 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 />