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uia-ieu-uu�u �.iry �i Leprryrnms rire rax-uie-iuu-uuzi <br /> Permit Appiication <br /> Date Received Phone Contact for Permit ��� <br /> Owners Name ^ Owner's Phone Number ��� � "7 <br /> Owners Address � �(�{ � <br /> Fee Simple Titleholder Name Titleholder Phone Number C] � C� <br /> Fee Simple Titleholder Address <br /> ... :ns' ' j.,' - ' - ^�.g.,: ..+.+.„.:r"': ^;,f,;. <br /> Job Address Lot # �� <br /> Sub Division Parcel # <br /> . , �, ,°� .,.., ,r. .,;.�. .. ,� ::..� s <br /> » ,. .. ., -•:. �-r� - :�•.a�...::...... ��. .<rc:, r.�, e <br /> � Bio-HazaM 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 Generetor> 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL � <br /> ❑ � emi � er � ( / <br /> Sprinkler ❑ O � Recreational Bum ' ! , `� <br /> l/ <br /> Fire Alartn ❑ ❑ � Sparklers j <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ �� � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> a Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Fiammable Application- ANNUAL r-�-� Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> . . . <.�, - , ..,.a .. . �., r . <br /> , � ,.. .. <br /> Contractor ,. Company ! � K ` ; r . . <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 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 ovmer) <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 />