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813-78p-p02U t;ity ot cepnyrnins rire <br /> rax e <br /> Permit Application <br /> Date Received ^' � Phone Contact for Permit <br /> r <br /> Owner's Name <� , , _� . . . __ , _� <br /> r� Owner's Phone Number � 3 20,�' 8? <br /> Owner's Address �"tjf <br /> Fee Simple Titleholder Name (--� �� �� <br /> Titleholder Phone Number I I <br /> Fee Simple Titleholder Address L----J <br /> c t -.� - ..e.��.. <br /> - - - c� ; .,.s�., t ,..,� s " `e � a . 'q � ^ ,.., : .. , __, - _ - <br /> - -' `�' E " k 5,: f,'•i7,:� - � <br /> JobAddress 7� .�' �'/j � _.� <br /> Lot # �� <br /> Sub Division <br /> ` � �., ,�_„�� A ,� � Parcel # <br /> �_ �r.. _ . a. :es , _ �,,:.z� _ _ <br /> � — - r�».^-�`-.a . . t�a —� _:r:KS:�,re����:N�v^�a..w.e�:.. <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 � Hood Installation <br /> � Emergency Generator < 30 kw � <br /> � LP/Natural Gas-Installatio� <br /> Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL a � �� � <br /> Places of Assembly-ANNUAL � <br /> r y emi � er <br /> Sprinkler <br /> � � � � � Recreational Bum <br /> Fire Alarm p � <br /> � � � Sparklers <br /> Hood Cleaning p � � � ❑ <br /> ❑ Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ C� � 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 <br /> a Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> ► <, _�, «�;;�.;:� =, �� � .,- . ,�: �;- <br /> '{#��ri:'a. ^:YgJ � '-?. _�� :Td. R 3 : + ��FSI:'+K"s�NY`i°,cs`Y"���R"#.+r- ,� -. . <br /> . ., . . , Sf':���Y�.,,"ME,'.'r�<,,-`4�.:-«.....� �."�' _'."-�£a'.'��••^��`3.':?*;.�'; °, '_ <br /> Contractor , <br /> Signature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Ad <br /> License # <br /> ELECTRICIAN <br /> Signature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> �LUMBER <br /> 3ignature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> dECHANICAL <br /> iignature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> 1THER <br /> ignature Company <br /> Registered Y/ N Fee CuRent Y/ N <br /> Address <br /> License # <br /> irections: <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 htt //a <br /> ( p: ppraiser.pascogov.com) <br />