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uia-iuu-u��� t,i�y oi �eprrymnis rire rax �,j,� J� <br /> • Permit Application �� <br /> Date Received � .� � � � Phone Contact for Permit � �� �� <br /> Owner's Name �/" L �c�._ (,t_Il Owner's Phone Number D(-j 73 �I �� <br /> Owner's Address Q( � 1 1J <br /> Fee Simple Titleholder Name Titleholder Phone Number �� �� <br /> Fee Simple Titleholder Address <br /> ^ ,a. :g 5��.:SL6r .. .h.� . '.' . .. <br /> Job Address 5�(� I ��,-? G� • � <br /> Lot # � <br /> Sub Division Parcel # <br /> r* . , F . . - e,... .� ,. . . . , . . .< .... ;...�.. .. . - - . . . <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-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 ° - <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum � <br /> FireAlarm � ❑ ❑ ❑ � � Sparklers /�.�`� <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alartn 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 Company <br /> Signature � Registered Y/ N Fee Current Y/ N <br /> Address Y License # <br /> ELECTRICIAN Company <br /> Signature I Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> PIUMBER 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 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 />