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sis-�ao-oozo c.ity ot �epnyrhms rire <br /> hax-tt1 � <br /> Permit Application <br /> Date Receivetl <br /> ` ~'�'^'^"'�^°� � ._ Phone Contact for Permit � � � <br /> Owner's Name � � � � � <br /> Owner's Phone Number � <br /> Owner's Address �5 y� U h � l��� � 3 3� 113 <br /> Fee Simple Titleholder Name � �� �� <br /> Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> E ` <br /> - " = - - _ «r2�. ;:.,i�:•;� �.rt«3 E . <br /> Job A - ° ��;:.:.z�x���..,�' :.::e,: e u — � ° <br /> ddress -��=s # _�>. �.�r. �- ��: r�,: <br /> �°�'s�.s,� <br /> Lot # C] <br /> Sub Division <br /> c � �w ��.,,�.: „a r :r.:��,�,¢,..na:�,,:._. Parcel # <br /> �' '�a•.���E� <br /> � s nc - >x•.,..r--�.: , - ,?r�.�o_, - 1.�-� ��r.< . :Yw�s+;���:� - - <br /> Bio-Hazard Waste Storage -ANNUAL � �%" "'`���""``"�'��="�''�"���' <br /> a Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct a Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Burn Hood Installation <br /> � Emergency Generator < 30 kw � <br /> � LP/Natural Gas-Installation <br /> Emergency Generator > 30 kw � <br /> � LP/Natural Gas-ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL <br /> r y emi � ef Places of Assembly-ANNUAL <br /> � y � <br /> Sprinkler � � � ❑ <br /> ❑ Recreational Burn <br /> Fire Alarm � � � <br /> ❑ Sparklers <br /> Hood Cleaning p � � � ❑ <br /> ❑ Sprinkler System Installations <br /> Hood Suppression p � � �� ❑ <br /> � Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation � <br /> � Torch Roofing/Tar Kettle <br /> Fire Pumps � <br /> ❑ Waste Tire Storage ANNUAL <br /> Fire Worics <br /> � Flammable Application- ANNUAL <br /> � Fuel Tanks Valuation of Project <br /> Q Other: <br /> s - ����::n.;� �., ,� � �, -., _ <br /> :���:t.�,�,:�_ : �„ . <br /> Contractor , -_Y, -. ,.k�.�u.ne��,_- � a `»�'�-�w�+,;�,�-�A�s"�m-.�=�=�n�°,;�;�r�•,�,,:. <br /> Signature (/7 �^� Company <br /> Registered Y/ N Fee Current Y/ IV <br /> Address <br /> License # <br /> ELECTRICIAN <br /> Signature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> PLUMBER <br /> Signature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> MECHANICAL License # <br /> 3ignature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> )THER <br /> �ignature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> �irections: License # <br /> Fill out application completely <br /> Owner 8 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. Parcei #- obtained from Property Tax Notice htt //a <br /> ( P: ppraiser.pascogov.com) <br />