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uia-iou-uu�v �,izy oi �epnyrnnis rire rax-u�s-iau-wzi <br /> Permit Application <br /> Date Received Phone Contact for Pertnit �_� ��] <br /> Owners Name �i /� �1 C �r Owners Phone Number � �� � <br /> Owner's Address S c � o 2 ('J /� S'� z `� ll /—� - <br /> Fee Simple Titleholder Name Titleholder Phone Number �� �� <br /> Fee Simple Titleholder Address <br /> - - - .-s . � : - .-:r;�,..^�.d.� .ax . � <br /> ,�.. s <br /> Job Address Lot # � <br /> Sub Division Parcel # <br /> , ., . m "L. .. .� .-k�� , - .. , <br /> - . .. _ ... .,. ».� ., ,. .. ,. ... . y. . T! r.a ..Tas:..:,w�•..i .,, , t' _..i . . <br /> � Bio-Hazard Waste Storage -ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier 11 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 /> � emi � er <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � a Sparklers <br /> Hood Cleaning �❑ ❑ [� � � Sprinkler System Installations <br /> Hood Suppression � ❑ f� ❑� � Standpipes (Sprinkler Sys) <br /> a Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> a Flammable Application- ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> . ,� ..�,,.w.. . . , ., . .,,:. . W>,:�•> , . .e . .� - �:-,n� R3 :$,- :.. . ., , . , ,. , . ,. � <br /> � : . :�; sra: . ._ . , ... ^.e�: , . . . <br /> Contractor Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> ELECTRICIAN Company <br /> Signature I 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 Sc v � �g t <br /> Signature � Registered N Fee Current �� N <br /> Address License # pp <br /> Directions: .,. . . � , _ .. _ ... . . <br /> Fill 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://appraiser.pascogov.com) <br />