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'"-- ---- vi�y vi �cNiiy��nuo � �ra raX-tSl5-780-0021 <br /> Permit Application <br /> DaC� Receivad ���3i?V �� - - � <br /> ^ Phone Contact for Pertnit ! 3 �l ?� �� <br /> . a.=�s�a� <br /> OEvners Name Owners Phone Number ��� � <br /> Owners Address <br /> Fee Simple Titleholder Name Titleholder Phone Number ��� <br /> Fee Simple TiUeholder Add�ess <br /> L� �J <br /> �F� - <br /> -..�cs�ew�c, .e.�a+�,,. �'at_ � a.�,.... --"�-� _s �- 5.�c'. . �- . <br /> Job Address � �' 1�wpc�� � �r►lYl� .�`f �� G P � <br /> Lot # <br /> Sub Division Parcel # <br /> � - �..,����.Q.. - - - � -- �. ��.c�= - .as <br /> a Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> Q Comm Exhaust Kitchen Hood/Duct a Hazardous Material (Tier II or RQ Faciliry) ANNUAL <br /> a Controlled Bum � Hood Installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Instaltation <br /> a Emergency Generator > 30 kw a LP/Natural Gas-ANNU a e f <br /> a Fire Protection Maintenance - ANNUAL a Places of Asse y-ANNUAL <br /> ❑ r y emi � er <br /> Y <br /> Sprinkler p ❑ ❑ a Recreati I Bum ���� <br /> Fire Alarm � ❑ ❑ ❑ � � Sparkle �� / <br /> iiood Cleaning � ❑ ❑ p� a Spri�kle System Inst lations <br /> Hood Suppression � t p � p� a Standpipes ler S <br /> � Fire Alartn Installation � Torch RoofingfTar Kettle <br /> Q Fire Pumps � Waste Tire Storage ANNUAL <br /> a Fire Works <br /> � Flammable Application- ANNUAL Valuation of Project <br /> Q Fuel Tanks <br /> Q Other: <br /> Contractor �' Company � � - /.J- - F, �� �,� <br /> Signature Registered Y/ N Fee CuRent Y/ N <br /> Address y7�( .�iG �r (�- <br /> T ( License # � � y� 3� 1�d�, r�.� � <br /> ELECTRICIAN � <br /> Company <br /> Signature Registered Y/ N Fee CuRent Y/ N <br /> Address <br /> License # <br /> PLUMBER Company <br /> Signature Registered Y/ N Fee Cument Y/ N <br /> Address License # <br /> MECHANICAL <br /> � Company <br /> 5ignature Registered Y/ N Fee Current Y/ 1�I <br /> Address License # <br /> OTHER <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> Directions: - <br /> Fil out application completely <br /> Owner & 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 (hitp:/lappcaiser.pascogov.com) <br />