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p1,7-IOl.-VVGV lil4)/ VI LCEJII�/IIIIIIS f IIC �dX-613-/CU-UULI <br /> Permit Application <br /> Date Received r Phone Co�tact for Permit ��� <br /> Owner's Name a Owner's Phone Number � 3 �-� �o� <br /> Owner's Address 3F�'3�/ (,. �E Z� ! - <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � <br /> Fee Simple Titleholder Address <br /> <.a'A: �c-: �a�'�,YS;.tc�F,°Ft.'E*'i`?R?',+3"v::'i�«� �:�; .� i+ , . .z a?.'b;.�":i;"'�5*.r�'a".A�3::e rggk . ., . .. <br /> Job Address Lot # � <br /> Sub Division Paroel # <br /> � . _ ..d:.��:.�. . s�r ^�5p,.6#zs.'�:'�a=., a.��;��:i�*;�.....�� .s .. .. . � a,= _,.. .� . .,��M.,>-::l,�tt�:<„�.t��..'�,.,.P#a'�--a�.�.'�4tf. a .....� - , a�.. .. .� .. � <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> Q Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Bum Q 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 � er <br /> Sprinkler � ❑ ❑ ❑ � Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ,� ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ � ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alarm 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 /> . ... . . " : . .. . :n' �,+f*3.2`:+a,:�k', .. _.s ..:...-.... r, . » .. _ , . ,. .. ., , . . . ... .� .,.:;3; `;±:' ...:•�.=�:.`A ,. . . ;.'v:;.w,":he ., . . e a x� . e � <br /> Contractor Company <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 /> MECHANICAL Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> OTHER Company � B�r. T ri ��C"•r(� e 7� L� <br /> Signature Registered N Fee Current N <br /> Address License# �1�'!o p � <br /> Directions: � _ - ,., ,. .. . , _ . . . . ., ... H. . .._ , � ., ... .. .... . . � � <br /> Fill out application completely. <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contrect with owner) <br /> If over $2500, a Notice of Commencement is required (Mechanical work over $5000) <br /> Supply two (2) sets of drawings with appiicable documentation <br /> Allow 10-14 days for review after submittal date. Paroel #- obtained from Property Tax Notice (http://appraiser.pascogov.com) <br />