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ais-��u-c�ozo c,it orce n mius rire <br /> Y P Y fax-s�:�-isu-uuli <br /> Permit Application <br /> Date Received Phone Contact for Permit <br /> . , �r � � �� atm�mtcm+..v.._ , _ ._ .r , - - �,.,�., .., e <br /> Owners Name � ��_�-j Ovmer's Phone Number �� C� N � <br /> �J <br /> OwnePs Address ��ll/�" z� � � �• <br /> Fee Simple Titleholder Name Titleholder Phone Number �� C� �� <br /> Fee Simple Titleholder Address <br /> � _._ _ ��^�^.��. ..€r° .'�%�°;;�".�.�.:.�..=�"��;c'�s �� .�:. - <br /> wa.�:�?a d" :W,�;.^' '=t:'.5" . �'��^--'.�"�"°'Xt' . <br /> :�- <br /> Job Address Lot # �� <br /> Sub Division Parcel # <br /> � .,.t ,.,�:.�.;�.�._ .. ,�,.��;.�. - ,. . ,� . <br /> . _ .��aaa � :�.� �,-�r w� �,� e,.��w �,� <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/Naturai Gas-Instaliation <br /> � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> ❑ � emi � er ❑ <br /> Sprinkler ❑ ❑ ❑ Recreational Burn <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning �� ❑ ❑ C� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ C� � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation a Torch Roofing/Tar Kettle <br /> a Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable App�ication- ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> F - 'e°��"�kx: ,a.a�e .... ;.�.t: .x,:�2;:a"�at:^�F"at. x.a . _._ . ; anry�s*�.# •�ga <br /> �s:—a:,ns°-•°��:.:�.o'dg'>§k�t�'SK��'1°'k.':�'.'N.ffi7,s°4t�+`w�Rriffi ,�'e"�;'�.a�'X�:?a"1� <br /> Contractor �� "' <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ PI <br /> Address <br /> License # <br /> ELECTRICIAN Company <br /> 5ignature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> �LUMBER <br /> Company <br /> iignature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> �AECHANICAL Company <br /> iignature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> )THER ' Company ' v � - �i���srx , �•✓7 �Le <br /> �ignature Registered N Fee Current N <br /> Address <br /> License # � � <br /> �irections: <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:/lappraiser.pascogov.com) <br />