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�i �ity or �epnyrnms rire hax-813-/8U-UU'L1 <br /> Permit Application <br /> Date Received � � Z� ��� � � � Phone Contact for Permit �� � <br /> C R # SP,1'� } <br /> Owner's Name � A s S dS Owner's Phone Number �� � <br /> OwnePs Address � �JS l/ C761�� ,C7 �V'Or <br /> Fee Simple Titieholder Name Titleholder Phone Number �� � � <br /> Fee Simple Titleholder Address <br /> E - <"�as �,°�' �;�i�:�. � »�e� "�ts-�.'��:.ticuC�:°>s�^-�r�,�t,°tc°�":s.s�"'=:a>���:Se _ __ � � , �� <br /> �'` <br /> Job Address � bsO �j� �I V� Lot # � <br /> Sub Division Parcel # <br /> 9 it'.« S: ,�p, a ..��.^,�ia:.y -r�;.;-.�F.TE!-�_ '.t . ._'3�Yo-"a:'5,�� �s;.':FlsR/CfiR�te, ,; _'4: °:d"+3bp:.� <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation <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/Natural Gas-Installatio� <br /> � Emergency Generator > 30 kw � LPlNatural Gas-ANNUAL Sale <br /> a Fire Protectio� Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> �y emi �n er <br /> Sprinkler � O ❑ O� � Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers � � �� ` l <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ [�1 � � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kerile <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 /> 1 ,�°�".F. K Pt7't3:n:#../.ld« P' .�,. _ .r � .. �- >� t • - t— . <br /> ..�.F'7:�"" : "�^.°.•'AfX.'.m2'�e • °=b' � . 'kw'Y:J:';alaF� , �_... � . � <br /> 'k9'Ltx ;iTro.n`2�1a.y „ye ...... ... . .. .^iF'�.^ <br /> Contractor Company � 5 �" �t � <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address � 0 Q�tEr r, j f qK <br /> L License # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> PLUMBER Company <br /> Signature Registered Y/ N Fee Cument Y/ N <br /> Address <br /> License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> OTHER <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> F 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 />