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si3-�s°-°°1� Lity or cepnyrnms rire rax <br /> Permit Application <br /> Date Received � L �� Phone Contact for Permit $� 99 (� 6 6 <br /> r n . .� �, - - - . _ _ .,, �� ° - . ,. . . . <br /> Owner's Name � Owner's Phone Number 8/ 7e�8 T,�B <br /> Owner's Address `/ Z l•�j`L � �� „�j' 3 s7� <br /> Fee Simple Titleholder Name Titleholder Phone Number ��� � <br /> Fee Simpte Titieholder Address <br /> ; : . ,��..:,_ � <br /> `_a :.3`. `4y�'.�.$'.�'.�<-'�..'�.]; '^ ._ � _ '3F �7:�.'°4'e"�,4�M*no».; -_'- , ��„�,q`� <br /> Job Address ,S/9?/Y`' 4 �� <br /> Lot # <br /> Sub Division Parcel # <br /> � - .v.� _ ,;.; � ,.. �.. � _ . ��^mt:e. . _ .,�:�.�':��u� <:�,.xw.. . . <br /> " �µ'e:.�x.. ,,... ,+�- .^�=�Fi�a , _ ,_ �-'f�C« . ,�c,�ks-r:'�::�:�.�?. <br /> � Bio-Hazard Waste Storege -ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUA! <br /> � Controlled Qurn � Hood Installation <br /> a Emergency Generator < 30 kw � LP/Natural Gas-Installation ��- <br /> o f`� �.� ,� <br /> Emergency Generator> 30 kw � LPlNatural Gas-ANNUAL Sal �'�� / ,,r <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNU �,../ <br /> ry emi �n er <br /> ❑ � ❑ ��„`'-- ..�-�"� <br /> Sprinkler ❑ ❑ ❑ Recreational Burn <br /> Fire Alarm � ❑ ❑ ❑ �� � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ �� � � 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 /> R W'tt'3?'�c{'T+A%.:� "°a�et. ': �T: a_ ,'.y4 $"�c�;�.°�S?� �1A!rfiR'�t. " y .] s . ':x'".*�:�3'i>+5."�idYSC">X:sst e.�`x.[',"Wn[a.5:d'��P��Y'a,�'F�;ia%�+}: ��", °S<'_ <br /> Contractor Company �` <br /> i � <br /> Signature Registered Y/ N ee Current Y/ N <br /> Address D Y63 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 <br /> License # <br /> OTHER <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <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:!/appraiser.pascogov.com) <br />