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sis-�so-oozo c,ity or �epnyrnius rire fax-ttld-/SU-UU'L1 <br /> Permit Application <br /> Date Received Phone Contact for Permit �� <br /> � <br /> Owner's Name �� jj'L � �� � L,� D S C f!() alq S�- pwner's Phone Number �� � � 6 <br /> Owner's Address G� �`t 5 �986v � S �� ri �� � '' 2 -� �( j� � <br /> Fee Simple Titleholder Name Titleholder Phone Number C� �� <br /> Fee Simple Titleholder Address <br /> s ._ _ ,a _ ,=.�t:aa,�'aa�a�:�m�; _: �:a�`�_ atuma#&.;�U. - :���� <br /> r � �.' '� sl:'. ��-�.�*�°"-'- - - - 7::'-�'.'.,,:."-,�'"rw"'�."..%3'7�', <br /> Job Address �, � �S � �0 � �j�Yf T lU� y� �Z � _../� / . ,- � <br /> ( <br /> Lot # <br /> Sub Division Parcel # <br /> 1' ' :'6rh. f�� ^:.'.Yi+A a.,- °R Rk0?'.YN'?'6'J�"*�z.+`°k.Ks::_-. <br /> _ _ _ _ _ - ,_ iii'�1As+rt-4s': "� _ _ _ _ _ ,'fF!��'!9... , Sn..T�', 1"$�%;:.wY's'A�'Z'F@'^Yr��R��a <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 � Hood Installation — � <br /> � Emergency Generator < 30 kw � LP/Naturai Gas-Installation <br /> � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sa � <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNU ��� <br /> �y emi �n er ; � �j <br /> Sprinkler � ❑ ❑ O� � Recreational Bum j <br /> - ` F• ' Alarm , � ❑ ❑ � � � Sparklers � <br /> �- - Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> a Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps a Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL S� Valuation of Project <br /> � Fuel Tanks <br /> Q ot r: <br /> � ,� ,�; �.-, R. ����-„�:�: .�-�-��-����:.��-�...1,�. a��. : . . ._ : _ _ � <br /> .�.*g� . . `:�.r„�F:YPF-°ie .., .... .,_ `�;e9G.:?;f..'ss".F+;�'-��'ln'?P.;e .,, � Ym... -.:'L' .'Cl�',�?E'*i'.re.s.. <br /> Contractor Company ,E✓1t.cp'.f-n� l�'LC <br /> Signature �' � Registered / N Fee Current / N <br /> Address License # e��kl ocY`C Il �r <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> PLUMBER <br /> 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 <br /> 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 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 />