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a��-�so-oo2o c:ity or cepnym�us f�re <br /> D 1�/�� Permit Application F�-���-�so-oo2� <br /> Date Received <br /> Phone Contact for Pertnit ��' � 7� r i <br /> Owners Name ��p{�' ��� �✓l 1'O� �f'"�O i I 3 �� <br /> � Owners Phone Number <br /> Owners Address (a `�(� ��� t r� 1 � � � 5 L��5,�,� <br /> Fee Simple 1'itleholder Name �� �� �� <br /> Fee Simple Titleholder Address l`rtleholder Phone Number <br /> Job Address �D �� / .! ►�t OQG�- 1 V'j'l t � �� � �,(.. .� �1�� �� <br /> Sub Division Lot # <br /> ��� # oa- �-oz.l- ooi o- o3q� Do6o <br /> � Bio-Hazard Waste Storege - ANNUAL � <br /> a Fumigatfon Tent <br /> Comm Exhaust Kitchen Hood/Duct <br /> � � Hazardous Materia� (Tfe� �� ar RQ Facility) ANNUAL <br /> Controlled Bum <br /> a Hood Installation <br /> Emergency Generator < 30 kw � <br /> a LP/Naturai Gas-Instailation <br /> Emergency Generator > 3p kNr � <br /> a Fire Protection Maintenance - ANNUAL �P�Natural Gas-ANNUAL Sale <br /> a Places of Assembly /1NNUAL , <br /> ❑ [c� emi � � ❑ <br /> Sprinkler i / Q / � � �' <br /> Recreational Bum � <br /> Fire Alarm ❑ O ❑ r � � �/ <br /> � L� � 3Perklers ,� `"� � <br /> Hood Cleaning � 0 � I"' ❑ S <br /> ❑ I_ � prinkler System Installation� <br /> Hood SuPPression ❑ � O I� ❑ <br /> � L-- StandPiPes (Sprinkler Sys) �----- -- <br /> Fire Aiartn Installation � Torch Roofinglfar Kettle <br /> Fire Pumps � <br /> Fire Works <br /> Waste Tire Storage ANNUAL <br /> Flammable Appllcation- ANNUAL ��--�--� <br /> Fuel Tanks � 6 ��'" 1 Valuation of Project <br /> Q Other. <br /> Contractor <br /> Signature �, Company re � la✓1 SY1c�� <br /> Address ���� Y N Fee Current (� <br /> '7 1 D �'t ►raFP,,.:� �as�ra,P l�z,c'-r' `-� �.. 3� license # <br /> ELECTRICIAN <br /> Signature Company <br /> address Re9istered Y/ N Fee cumerrt Y/ N <br /> PLUMBER u�e�+se # <br /> Signature Company <br /> Address ��s�� 1r / N Fee Current Y/ N <br /> MECHANIC Lloense # <br /> Signature Company <br /> Address ��s�"� Y/ N Fee current Y/ N <br /> OTHER <br /> License # <br /> Signature Company <br /> Address �� Y/ N Fee Current Y/ N <br /> Directions: License # <br /> Flll out application completely, <br /> Owner & Cor�ractor aign back of application, notarized {pr� copy of signed ccnUact with ow� <br /> If over $2500, a Notice of Commen�ment is required (Mechanical w�ork over $50pp) <br /> Supply two (2) sets of dra,M�9s �h appltcable dxumerdation <br /> Aliow 10-14 days for reviemr a{�r submkfal date. <br /> ParGel #- obtalned from ProDe�tY Tax Notice (httPy�aPPraiser.pascogov.com) <br />