Laserfiche WebLink
uie-�ou-uu�u �,ity oi ceprryrnuis rire rax <br /> Permit Application <br /> Date Received � Phone Contactfor Permit / j 7 p/'Z� <br /> ... _ _ . . .....� •:.. > .._:_. , - .. .. , .. . , -� � �� <br /> Owner's Name � �-g- Owner's Phone Number � 7 f� C <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number �� �� � <br /> Fee Simple Titlehotder Address <br /> .... �. ., . `.:*"�n`�::k:.4`&�'•:',9Y?'` .::p - . . ' '�#'.3'a <br /> {�: zJ^a''i: r&'}:�S'i #i+ZE: �.5� <br /> Job Address � � � � � J �'� �/ � <br /> � / � � �'" , �-S Lot # <br /> Sub Division Parcel # <br /> • ..�. . ,- • ... .. .. .�,„- ... .,, ,. _�.. . . _ • . . . . ,. _ .�-.K. �. a. _ ; _ .._ �.. , � <br /> .?' 3: <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 2 <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum � l � �� <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers / <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Suppression ��Y p ❑� a Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> n Fire Pumps � Waste Tire Storage ANNUAL <br /> �� Fire Works <br /> � Flammable Application- ANNUAL Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> .._ , �>.. r. , . � . , . . . . ..� , <br /> Contractor _ Co any <br /> Signature -� istered Y/ N Fee Current Y/ N <br /> � � L(/ <br /> Address � ,�,c/ , �,r., r '� � 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 Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> Directions: � V ' <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:!lappraiser.pascogov.com) <br />