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�i or �e n rrnus rire rax <br /> si 3aso-oozo tY P Y <br /> Permit Application <br /> Date Received, Phone Contact for Permit �� � <br /> m Owner's Phone Number � � �� <br /> Owner's Name ' I `4� <br /> Owner's Address ( ��� �G, L �J � <br /> Fee Simple Titleholder Name Titleholder Phone Number �� �� � <br /> Fee Simple Titleholder Address . , .,__ <br /> : .,9. .; £n " � -- ."C.�"$- iTas'i+':u'&�m4�dii'.A['�✓_ ,. 4`_ps:3�'.$Rvx: +�:'dfli...*"�.; _ 'P'^,5'. F9.•'�.k <br /> p x - _ �. ' �2nP:k75`£�?u�ay„ a�'t�'!':"�; n '=�"' - � � <br /> Lot # <br /> Job Address <br /> Parcel # <br /> Sub Division �wa�3�ng -,s.�:. �°« �a . ..� ,.,.�. .. . ,:.,�:,.��*�,: + <br /> p , w �c s�r.:.�_,.- .�.�rt - - - - - ..a�;�--;�aen.-�x�sx���.� -�a;.:�-...-s �- . ��. _ �.- - - - <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct Q Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator > 30 kw a LPlNatural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> ❑ �y emi � er <br /> Sprinkler ❑ ❑ ❑ � Recreationaf Burn � 'f ��� <br /> � !/ <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑�� � Sprinkler System Installations <br /> Hood Suppression ��� � � � � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Instailation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL Valuation of Project <br /> a Fuel Tanks <br /> Q Other: <br /> h 3`��'k`+�L , �«s � ., ..�'�`ds'-.+'F �^ , � , :;� . •::�^+�'a.�:,�::-�.:°�nl , i7;.t�.�d . �,:s"'ria.�.*,teT�.:s^iY;ai°5�^rt%A�'.�aSe& <br /> Contractor Company : <br /> Signature Registered Y/ N Fee Current Y/ <br /> Address License # <br /> ELECTRICIAN Company <br /> Signature <br /> Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> PLUMBER Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N Fee CuRent Y/ N <br /> Address License # <br /> OTHER Company <br /> Signature Registered Y/ N Fee CuRent Y/ N <br /> Address License # <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 Property Tax Notice (http://appraiser.pascogov.com) <br />