Laserfiche WebLink
813-78U-0U20 C:tiy OT Le(JhyfhIllS rlf@ rax-813-/8U-UUZ1 <br /> Permit Application <br /> Date Received , �� 3� � Phone Contact for Permit I,3 � <br /> F� . . , _ .. -. , r� _ _. _.H.n . .. _ z v � . Y �• `_ - . , m _ <br /> � � ' / � � � <br /> Owner's Name 1 5 , � r v Z� /�� Owner's Phone Number <br /> Owner's Address <br /> ' � S �� 5�3� Z <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � <br /> Fee Simple Titlehoider Address <br /> � _ _ _ >»^."-._ «.3:.'�4.'"5`a�ge: _ - r xs ::S���'.':-;^ c a'�; :aa#�' � ":'fim'.:::°:a';� g . � _ <br /> . _ _ ' _ __ ... ..-i.�£:u'". <br /> Job Address � � L�.,.J � � <br /> Lot # � � � <br /> Sub Division Paroel # <br /> t .,. _,,:.�.x=+� , .. m a ,. _.. .�s.. �._ �a��aff� -. . � <br /> -� - - - - drrc_ �svA�:v,.:�.�rs`� - - - *�#ara�yr� ' _ M _ , .ma;.5�u�:.r,,,•��m^s <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> a Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Burn � Hood Installation <br /> � Emergency Generator < 30 kw � LPlNatural Gas-Installation <br /> � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL �[-/' <br /> �y emi �n er � I �J,y � <br /> t d . <br /> Sprinkler � ❑ ❑ ❑ � Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kerile <br /> Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> , � ,xF.. . .r . . .. ..�::�,f ��� , � ��..��<.:��. ���..�;,��,. t ,�,� ,. . � . .. <br /> . `4 x :'"'�.F'+ -'Ab<'�rci°Yr;c�?'?",• w.,�.�.. <br /> Contractor Company <br /> Signature Registered Y/ N Fee Current Y/(�I <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 <br /> 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 <br /> License # <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 />