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a�s-iau-uu�u <br /> �iry or cepnymuis rire <br /> Permit Application rax-ai,�-i�u-uun <br /> Date Received t� ��� <br /> ` .. _ .. , . . Phone Contact for Permit Y � <br /> Owner's Name r�/�T � � �) J�� � �� '� <br /> Owner's Phone Number � <br /> Owner's Address G� L C � j �` <br /> V <br /> Fee Simple Titleholder Name ^ �� ,�—^ <br /> Titleholder Phone Number L__� u <br /> Fee Simple Titleholder Address <br /> " �°�_"� .-- °.�'�*�':r �H.��z=��.,: <br /> Job Address � � T- K � ��`°��': <br /> z���_��a . <br /> Sub Division <br /> Lot # �� <br /> r N�., . .�; � ��. Parcel # <br /> � ' - , �a:.s�a, a� - _ �aa� <br /> Bio-Hazard Waste Storage - ANNUAL � <br /> � Fumigation Tent <br /> Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Burn a <br /> � Hood Installation <br /> Emergency Generator < 30 kw � <br /> LP/Natural Gas-Installation <br /> Emergency Generator > 30 kw � <br /> LP/Natural Gas-ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL � <br /> Places of Assembly-ANNUAL <br /> � �y emi � er ❑ <br /> Sprinkler � � <br /> ❑ Recreational Bum <br /> Fire Alarm � � � � ❑ <br /> � Sparklers <br /> Hood Cleaning p � � �� ❑ <br /> ❑ Sprinkler System Installations <br /> Hood Suppression ❑ � � � ❑ <br /> � _J Standpipes (Sprinkler Sys) <br /> Fire Alartn Installation � <br /> � Torch Roofing/Tar Kettle <br /> Fire Pumps � <br /> ❑ Waste Tire Storage ANNUAL <br /> Fire Works <br /> � Flammable Application- ANNUAL <br /> � Fuef Tanks Valuation of Project <br /> Q Other: <br /> k ..a.Y. �S�i0..':�$P,1Pn�iv'�:3,:�T., <br /> �" ' <br /> COfltfaCtOf � ` '� '., <br /> Signature Company � � <br /> Registered Y/ Fee Current Y/ N <br /> Address <br /> ELECTRICIAN License # <br /> 3ignature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # �— <br /> 'LUMBER <br /> iignature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> �ECHANICAL License # <br /> ignature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> THER <br /> ignature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> rections: License # <br /> Fill out application completely <br /> Owner & Contractor sign back of application, �otarized (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 />