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tsia-�au-uutu �.iry oi �epnyrnws rire rax-ais-�tsu-wti <br /> Permit Application <br /> Date Received � Phone Contact for Permit �� �� <br /> Owner's Name �.�s� �s� G� i Owners Phone Number c��.� 7�.2 �S� <br /> Owner's Address ✓ --���U� ��° � �' ` � <br /> Fee Simple Titleholder Name Titleholder Phone Number � L�J �� <br /> Fee Simple Titleholder Address <br /> _. . . .:�.. .. t.�_� ' <br /> Job Address Lot # � <br /> Sub Division Paroel # � <br /> , u . � ..,, .e. ,....s. --. _ . . -- .: , . - . ,. �.. .�; �.._ . _. s .�.. . .. <br /> � Bio-Hazard Waste Storage - ANNUAL a Fumigation Tent <br /> a Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier il 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 Alartn � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning �- ❑ ❑ L� � � 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 /> 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 /> PIUMBER 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 S�Dc.��7 <r� ��� �P�7 « <br /> Signature C Registered G�7 N Fee Current N <br /> Address License # � lvS�O�'�� / <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 PropeRy Tax Notice (http://appraiser.pascogov.com) <br />