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si s-�so-oozo c;ity or cepnyrnms rire rax s <br /> Permit Application <br /> Date Receive� Phone Contact for Permit �� � <br /> � - - . _ <br /> Owner's Name % E � T.�Niv �..J''-�i��o�/ Owner's Phone Number �� � <br /> Owner's Address G�� y�i/� v�A �t �,�- ,��S y� 5 7� <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � <br /> Fee Simple Titleholder Address <br /> g _ a� �pr:eq.*- +v<.-. . .. ' `^5$i 'aP ,>r$gg�- - _. _ - �:aa.> .- 3a'�R , �"3�'X�.,��:;..�-:r�5�e , �:i�':,&:'�EC..a.a,�g -.. , :F'_r� ..z � - , . �.,,,-,-�caxws <br /> Job Address Lot # � <br /> Sub Division Parcel # <br /> �p R �_iaR..: . -..�n,axa=m�snR.i�Sw�^k+r . a_ .c.-,yC�'.r..yyy,. �.. , �a. ... ..m. *-. � . °s_�as .a��n{�`�R�'�".'>w ��T+�ir. , : <br /> _ _ __ _ � �".' "T.�'r�A`-^' - "'"".:�F-1C:�. <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> � Controlled Burn � Hood Installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> r y emi �n er <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Burn <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ �❑� � Sprinkler System �nstallations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation a Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � FlammableApplication-ANNUAL Valuation of Project <br /> a Fuel Tanks <br /> Q Other: <br /> r .-����_.. �� � . ; �-��,.�„���,. > .��.-. . .-�_r�����_ ��:-�. � . . - . ������ . , .v�wP�-��. a, w _ <br /> �x��„���� �.-. ,:.�.a, ;�,.� ;.;�:.�;�. <br /> Contractor Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> ELECTRICIAN Company <br /> Signature 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 Cunent Y/ N <br /> Address License # <br /> OTHER Company FPurr1 i,e� �v�'�,�,-,-,7 G L� <br /> Signature Registered N Fee CuRent / N <br /> Address License # � � ' dp(:Y// <br /> r <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 />