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a,sa�a-oozo c,iry or cepnymms rire Fax-81,i-/8U-UOZ1 <br /> Permit Application <br /> Date ReceiveG ~ f��! / <br /> � <br /> .. .. . Phone Contact for Permit � ,� . . ,.�-�s�. ., r � <br /> Owner's Name �� y�` ,�� � S (n/,�7 % Z x pwner's Phone Number C� C� �� <br /> �J <br /> Owner's Address <br /> Fee Simpie Titleholder Name Titleholder Phone Number � C� C� <br /> Fee Simple Titleholder Address <br /> E ',r ' ,,�"` �_ <br /> - - :" � : :'a:a '*,1*F'fi::..�'-�"F�'�t:�'�«:�.: e� - ^ , �«'�s�wl'#"%?w. _ - - <br /> - — - �b'%�:':«:,,.- <br /> Job Address Lot # , ��� <br /> Sub Division Parcel # <br /> �+ ., a :: . . : e. �,-- r¥,*c:'�?+at.+�,sxa. _ _ . i��k*�.:.. - - - �. �. <br /> _ � _ _ _ ;S ;'�A'E#M.`.:� �cF �- . _.. . .. _F.e.�_ ;t.; <br /> F. wm �aa <br /> '_ ¢.-•. .., _' _ - -�'=^Re�eee'�4.hk'.`.x'9�F:"'8' <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 a Hood Installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Instailation <br /> � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale '� <br /> Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL .^ �� <br /> � �y emi �n er <br /> Sprinkler � ❑ O � � Recreational Burn "�I � <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � p ❑ p� � 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 /> a Flammable Application- ANNUAL Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> a � t»���b: .$., < ... �, A , ,;w:�-�s � :,�.��-,�. ���..���:..�.,��eY r;;� �:s:... �.. . y..,�,,._,. d 5 .�, �.,��-x.,,f, x ��:��.:����:�;, -�_ :_ <br /> � <br /> Contractor � ��"����"- <br /> 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 Curtent Y/ N <br /> Address License # <br /> OTHER <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> Directions: <br /> Fill out application completely <br /> Owner & 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 Mro (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 />