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ai3-�so-oozo t;ity ot �epnyrnius rire rax <br /> Permit Application <br /> Date Received � � � � Phone Contact for Permit �� <br /> p - -_ _ -_ __ _ b.A <br /> Owner's Name /�6�G' G��/�� "� Owners Phone Number �� � � 22 � <br /> Owner's Address �� � (� ?� rS� <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � <br /> Fee Simple Titleholder Address <br /> 6 _ y ."'r.�-.'s -'t��:�k.�"T�:';�x'i�:��:P' ..S'9;"a�:'*�z°? 3 �=.�^.' 3`: •?�'m - '- _ _ ' "'�^. <br /> Job Address Lot # � <br /> Sub Division Parcel # <br /> p , . �»7R � -^..,,, ,�. ,.x . _ � - - - - �a.�. . _ � � "�s��;�uoe:��—.s�?scre � -.,-��"-�e��s:�a?��w�,�ta. - - - -' �:�rs - x�•�,� , _ . . _� <br /> � Bio-Hazard Waste Storage -ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Burn � Hood installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator > 30 kw Q LPlNatural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> �y emi �n er <br /> Sprinkler � ❑ ❑ ❑ � Recreational Burn -�'�' l Z-�VS <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 /> � . ���.3:-h.���,..�; -��-=a:-����a;�<<,_.�;� _. ���-�:.,�,�,�,.�:�� .x�. <br /> Contractor ,,�/ � Company ifjN� GS <br /> Signature xG!/L� Registered Y/ N Fee Current Y/ N <br /> Address s b !� •,S tGl�l 1/ty s'% � J n 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 CuRent Y/ N <br /> Address License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> OTHER Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> � <br /> Directions: <br /> Fill out application completely <br /> Owner & Contractor sign back of appiication, 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 />