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zsia-�uu-uv�u t,ity oi cepnyrrnus rire <br /> rax-ui s-i uu-uun <br /> Permit Appiication <br /> Date Received Phone Contact for Permit ��� <br /> � <br /> .. j , . . . . _ . ,. <br /> Owners Name ��5� � u� Owner's Phone Number �/� �� � <br /> Owner's Address �5�� f �f � S�, ��. . � ��'� C^ <br /> Fee Simple Titleholder Name Titleholder Phone Number ��� <br /> Fee Simple Titleholder Address �--� <br /> � .... � .,. � , �.v�,�°:�r - _ ;f*p,�.. - , <br /> ��> �ra�;rz>,t��� :r.*�-�.: �a. � _. � ., � <br /> � ,e.�.: �. , <br /> Job Address � <br /> Lot # <br /> Sub Division <br /> Parcel # <br /> � <- - .. -..:;�, �,:,.. a.>..,•>.�: xs••�.;:,::,� �:,;: Y �w:�.... �.. • _ <br /> = . --3�: �� ... , r. ����Q:.r.>�.=�n.,:xr^�:s.:�:.rs.�x>�;; �, <br /> � o. ,.e± .c,.. z;i:Y81. ..'- . ... :.4,-; .. <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/Naturat Gas-Installation <br /> � Emergency Generator> 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> ❑ r�y em� � er ❑ <br /> Sprinkler ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning �❑ ❑ �, �� � Sprinkler System Installations <br /> Hood Suppression ❑ �I( ❑ �� � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation � Toroh Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL <br /> � Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> Contractor ,�:,... . . , G , :r.:. ,�.r,�>.rt . , �. .. „ . <� ... .. : - - < .. , � �..- . _ � a .. � < � <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> ELECTRICIAN <br /> Company <br /> Signature I Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> PLUMBER <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> MECHANICAL <br /> Signature <br /> Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> OTHER <br /> Company • �� <br /> Signature tre. ��v me,vl <br /> Registered N Fee Current N <br /> Address <br /> License # (� d p !�%9' <br /> Directions: ` ' " —�_r <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 NoUce 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 />