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sisaao-oozo t,ity or �epnyrnms rire rax-aia-iuu-vun <br /> Perm't Application <br /> Date Received _ ��� _ � � � � � j Phone Contact for Permit �, `'�� � <br /> B { <br /> Owner's Name �"� � �� L v/�/ Owner's Phone Number q �� C� � 3 �� <br /> Owner'sAddress � O , �o� �I73� ��M�� � `� � / <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � <br /> Fee Simple Titleholder Address <br /> s a • r_ -. �. ,. � - : � . �-r�« .�. ,a v �..-�.,�r� ; . . � � -s-,.�.... ,..._ . , .,, .� �,-> ;�a��,s�. °rr��� r ��'.,,,�- „ _ . � 6, <br /> Job Address � �"M l � v� T �ZZ%✓ ��'�� �� ��� � Lot # �� <br /> Sub Division Parcel # <br /> p • _ _ . ..�r�. �srr�w,—. � , , _� .. .y. . : .aa�r°.�.�:a�c.i�ae��. ����. _ _,_ _ -#�;� _ . , _ _ . ,��.y�rF,:...� ��°mt�=� - <br /> � Bio-Hazard Waste Storage -ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> � Controlled Burn � Hood Installation <br /> � Emergency Generator < 30 kw � LP/Natural 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 � � / <br /> Sprinkler � ❑ ❑ ❑ � Recreational Burn � I ' <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning �❑ � ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation � Toroh Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL Valuation of Project <br /> a Fuel Tanks <br /> Q Other: <br /> � ��� �"�:.�`W.'G=�Y`. °rR�:x��+"��+�="`a.� y C�� .„�'��:�4-'`�"'Ffi;'.>`r��. AY^a'iT3°?` fl4`�'�r ' . <br /> Contractor 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 CuRent Y/ N <br /> Address License # <br /> OTHER Company <br /> Signature Registered Y/ N Fee CuRent Y/ N <br /> Address License # <br /> x. <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:Nappraiser.pascogov.com) <br />