Laserfiche WebLink
813-78U-OUZD <br /> �iry ot �epnyrhms rire <br /> Permit Application fax-al,i-/t3U-UU'11 <br /> Date Received j� <br /> ` . ' ...,��.,,_... _. ,,�:,;,, � Phone Contact for Permit � <br /> Owner's Name 30% �/L C� ° ;� 4 T, y' ,., <br /> Owner's Phone Number U �� � <br /> Owner's Address ! 1 <br /> � UU L <br /> Fee Simple Titleholder Name �� �� � <br /> Fee Simple Titleholder Address Titleholder Phone Number <br /> � - <-:�e�.;�...cs��:�.�r±��.:�.�w.�:^�.a- :�.;,�� <br /> Address - sr:w,.. �'�::;a�x��.s.�,r a� s.r. ,;,� � � <br /> Job � - �„�,� - - •�:;� <br /> Sub Division <br /> Lot # C] <br /> ► ° v :�. .:., ,=.,:�p��,�,: , . Parcel # <br /> �� �a _ ��+� �.� ��F-�� a . r,�.• <� ..: - <br /> � _�:�.;,;::_�«.¢�J��,<,<�u. ,_ � <br /> Bio-Hazard W aste Storage - ANNUAL � '�'�` `�`� �'<'� � �_�„,:�° ; :, <br /> � Fumigation Tent <br /> Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Burn � <br /> � Hood Installation <br /> Emergency Generator < 30 kw � <br /> � LP/Natural Gas-Instaltation <br /> Emergency Generator > 30 kw � <br /> a Fire Protection Maintenance - ANNUAL �P�Natural Gas-ANNUAL Sale <br /> � Places of Assembly-ANNUAL <br /> ❑ � emi � er r <br /> Sprinkler p � � ❑ �� / � � 2 3 <br /> ❑ Recreational Bum � <br /> Fire Alarm � � � �� ❑ <br /> � Sparklers <br /> Hood Cleaning � � � r� ❑ <br /> � �_J Sprinkler System Installations <br /> Hood Suppression p � � � ❑ <br /> � Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation � <br /> � Torch Roofing/Tar Kettle <br /> Fire Pumps � <br /> ❑ Waste Tire Storage ANNUAL <br /> Fire Works <br /> � Flammable Application- ANNUAL <br /> � Fuel Tanks Valuation of Project <br /> [� Other: <br /> z F. .,� . ., <br /> - ... . .. ,.:"£4��_F3�'.3%nr+• �'.��`fi'7nysw;9'$�"t*�':a�.,+.�,� _ <br /> Contractor a . . ..�a4 . -°:�-�- .. . � _ - �: �r��� ¢��H�:�»»�;�.�,.�, , - <br /> �. , . �-. = • '%+�:�-->�-•,�.,- <br /> Signature Company <br /> Address <br /> Registered Y/ N Fee Current Y/(�1 <br /> ELECTRICIAN License # <br /> 5ignature Company <br /> Address <br /> Registered Y/ N Fee Current Y/ N <br /> 'LUMBER License # <br /> iignature Company <br /> Address <br /> Registered Y/ N Fee Current Y/ N <br /> �ECHANICAL License # <br /> ignature Company <br /> Address <br /> Registered Y/ N Fee Current Y/ N <br /> THER <br /> License # <br /> gnature � Company <br /> ,Z _ <br /> Address 3d <br /> Registered Fee C ent Y/ N <br /> rections: <br /> License # z �1JU <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 />