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sisaso-oozo Liry ot �epnyrnius rire rax <br /> Permit Application <br /> Date ReceiveQ /� / 5� . . � Phone Contact for Permit <br /> Owner's Name '✓ b►t/�' Owner's Phone Number 0�/ � �.�3 3 <br /> Owner's Address J ( b� S� <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � <br /> Fee Simple Titleholder Address <br /> � �- .. ��� : a �a �,:,� _� , �ce�:-. �r ��?�a��, _ <br /> _�� ��� _. , <br /> Job Address Lot # � <br /> Sub Division Parcel # <br /> b , , �+Jet �..ia�R'aUee+4�_ +%Sfi• _ _ _ _ __ __ _ ., .'�:t^�', : _ �_ � - . _ _ _ . . _ _ , .. <br /> � Bio-Hazard Waste Storage - ANNUAL a 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/Natural Gas-Installation <br /> a Emergency Generator > 30 kw � LPlNatural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> �y emi �n er <br /> Sprinkler � ❑ ❑ ❑� � Recreational Bum �/'� / Z 53 3 <br /> Fire Alarm � ❑ ❑ �f � � Sparklers ! � <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � 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 Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> b �' _ ='#7t3r� - - :a_ �.+�:,. °_.�� . �. . . . .�kt`; ; a * ,... �,.,,S��s;ms,-w �'"+,'�;*«�;��.���� . .�s -�^d"` g , . - �::w� <br /> CoMractor � i� Company s'7 w� G�' <br /> Signature �/�� Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> ELECTRICIAN Company <br /> Signature Registered Y 1 N Fee Curcent 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 Current Y/ N <br /> Address License # <br /> OTHER Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> F <br /> Directions: <br /> Fill out application completely <br /> Owner & Contrector 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 />