Laserfiche WebLink
uia-iuu-uu�u - t,ity oi cepnyrnms rire rax-uie-iuu-uuzi <br /> ' � �� � Permit Application <br /> Date Received A Phone Contact for Pertnite �� Y �� <br /> Owner's Name '.� � E� .E � �✓C E, j K f il � G� Owner's Phone Number � 5/i � �'$ �sS Z <br /> Owner's Address /� ���� (�r lt(Q.St+� S} i� S , J c / j C�C�S/ � <br /> Fee Simple Titleholder Name Titlehoider Phone Number ��� <br /> Fee Simple Titleholder Address <br /> J <br /> . . . ,r, -#u'a:° e Y �>'..�a'`�. :��i'ir'td?.�# ':iS.4 " - <br /> .� . : ,�'r• . ` rv..�.�_'�"'��.��&.� 3`.i'�I'�'^,.«�.'Y�T.Di.,B�"^..� . ':;.xS: <br /> Job Address j' g.� iZG '� �� e- It.� rL � v f �� � S /�►�TC c�l� o z� ( S y C] <br /> � Lot # <br /> Sub Division Parcel # <br /> ; ' , ° � - a�•� :s�; �t�;�ay,�-z°.;::�r��:�.s: .,.,... .� - .. � - •� ,.. :���»�t���x.a.�.�:r; � <br /> � p - . a, . . �„ . 3�'.. 3e.. > ._ . .". : tif ••� ,, r ,. <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 G�nerator < 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 /> ❑ [�frTy] emi �n er <br /> Sprinkler ❑ ❑ ❑ � � Recreational Bum � f CE' � <br /> Fire Alarm � � ❑ ❑ ❑ �� � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ C� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ �� � Standpipes (Sprinkler Sys) <br /> � Fire Alartn Installation � Torch Roofinglfar Kettle <br /> � Fire Pumps - � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Fiammable Application- ANNUAL <br /> a Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> .. , �. ��. , .. -:�� -.xt�- � �:. . . . � , _ <br /> Contractor � , ° , -. . .c � . : -r: . .�� • ,• ., . , � : � . , <br /> Signature L� SC/_ ��-' � Company J�rG� of�� — , y � -�,�, y c � T <br /> 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 <br /> 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 <br /> License # <br /> OTHER <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> Directions: "" ' ' . , , , <br /> Fili 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:/lappraiser.pascogov.com) <br />