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sis-�so-oozo c,ity ot �ephyrnuis rire raX-ei�-iao-uuz� <br /> , Permit Application <br /> Date Received '� Phone Contact for Permit <br /> ' � .,. . . , . . _ _ � �.. . . . . � _ .. <br /> Owner's Name � Owner's Phone Number �� C� � <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number � C� �� <br /> Fee Simple Titleholder Address <br /> 6 _ c:: ..�s.a� _:�-�e�� _ �:��."��.7�,s:�.�.�at:�:.°.zt- as".�= .:�� � <br /> .�""�"2T,'-_ _ . ":u3':�"":�,.'�«^"�.`+�` <br /> Job Address � Q `� � �� � �� <br /> Lot # <br /> Sub Division Parcel # <br /> e „.. .� . ra,e�c:�:;,: av v.sa . - - - - - -- '.. - - - - ..�--��rrm. --v - _ _ "m .vn.�:»m,PK�;- ._ � ��.. <br /> a Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent d <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Burn � Hood Installation <br /> a 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 Bum <br /> Fire Alarm � ❑ ❑ p � � Sparklers <br /> Hood Cleaning � ❑ � ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps a Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL Valuation of Project <br /> Fuel Tanks <br /> Q Other <br /> � <.:��. . __ . �Kt ��� F� �.��,����� <br /> :�:�.�� ����,:. , .�-�.�:��,., . � u,�.�>�.a.,. ,. --�- . ��;. <br /> � 'K.. 6"tF"?�L.�s.wh':.e4'J. <br /> Contractor <br /> Company <br /> Signature Registered Y/ Fee Current / N <br /> . <br /> Address 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 Current Y/ N <br /> Address 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 /> k <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 lwo (2) sets of drawings with applicable documentation <br /> Allow 10-14 days for review after submittai date. Parcel #- obtained from Property Tax Notice (http:/lappraiser.pascogov.com) <br />