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� uia-�o�-uu�u �.�[y oi �epnyrnnis rire rax <br /> Permit Application <br /> Date Received " Phone Contact for Permit ��� �� <br /> Owners Name S p Owners Phone Number � 3 � <br /> Owner's Address l y � q � �, � S � 3 L! O <br /> l <br /> Fee Simple Titleholder Name Titleholder Phone Number C� �� <br /> Fee Simple Titteholder Address <br /> � - . �. a,;�; ::�• - .. e:� �;�,;��°�.; • �, x �».. <br /> Job Address � <br /> Lot # <br /> Sub Division Parcel # <br /> � Bio-Hazard Waste Storege-ANNUAL � . ' � 'a � YYF �' „# ~✓,.� � � � `#, f � <br /> Fumigation Tent <br /> � Comm F,chaust Kitchen Hood/Duct � Hazardous Materia� (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/Naturel Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL -- <br /> ❑ � emi � er ❑ <br /> Sprinkler ❑ ❑ ❑ Recreational Bum <br /> FireAlartn � ❑ ❑ ❑ � � Sparklers / <br /> Hood Cleaning � ❑ ❑ O� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ � �� � Standpipes (Spri�kler Sys) � <br /> � Fire Alartn Installation � Torch 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 /> . �. � , , . ... ,,:�.. :�-.::�-r..._. . . � . . . . :.. . � , _,��:� ��:� . . . . .w ::,� . ... ..a. <br /> Contractor ` <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> ELECTRICIAN <br /> 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 /> MECHANICA 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 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 />