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813-78U-OU20 c;iry ot �epnyrrnus rire Fax-81,i-/tlU-UUZ1 <br /> Permit Application <br /> Date Received f '�7� ���' � � Phone Contact for Permit �� � <br /> e • 4 c- <br /> Owners Name �Q1j 0►'['� Si ��frS Owner's Phone Number O' � � J � � <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number �� �� �� <br /> Fee Simple TitleholderAddress , ,�, .,,.,...:,. <br /> E ..r, - .. _>,��.>au �:s�,��*�.:-,��^�-.. _ � ° �-,.,_:��°>s;��:°�j�.��.��_. �°���`a�a <br /> Job Address � /` (� � I s V°' Lot # �� <br /> Sub Division Paroel # <br /> e �� �. ...... .. - ,.. �...a:.r�f,,.a.,.�.r��°�-..��f�. - , . k_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 Bum � Hood Installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Installation ��( / C7 <br /> � � LP/Natural Gas-ANNUAL Sale �� < < <br /> Emergency Generator > 30 kw <br /> a Fire Protection Maintenance - ANNUAL a Places of Assembly-ANNUAL <br /> � emi � er <br /> Sprinkler � ❑ ❑ ❑ � Recreational Burn <br /> Fire Alarm � ❑ ❑ ❑ �� � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ L� � � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> 0. - cTir�r�p.�^.�e - „ `.r---• "2�'�,.L:Y9...Y;;t,",x �._.. .«:+F�:a'#%�'P>P*,.�3�:c°k3YS�"-h;,:s:s „ n:�.r3'.,� ._ '_ -•.:^,r; _ .' ".'d.9.*..�.. ._..,3�'r..,4f�9h.'�'A�Y^'°.'. <br /> Contractor �' yy _ Company C� ld a3f ��rr 4� � Y <br /> Signature �' �� Registered / N Fee Current Y/ N <br /> Address �rze M anO� 1.1"i�C /"It'�'ii �i �.� FC- 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 Current Y/ N <br /> Address License # <br /> OTHER Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> f Directions: <br /> Fill out application completely <br /> Owner & Contractor sign back of application, notarized (Or, copy oi 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 (http://appraiser.pascogov.com) <br />