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si3-�so-oozo �ity or �epnyrrnns rire rax <br /> Permit Application <br /> Date Received � Phone Contact for Permit 99(� � <br /> , , - -. . .. __ .. , ,� .. .._ . � <br /> Owner's Name G-e � �`� Owner's Phone Number ��3 � 3 6/ <br /> Owner's Address �o CJ� �u << D��"` Z 1�� �J� <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � <br /> Fee Simple Titleholder Address <br /> t _ ��aa��. ..� �.�,�r�,�:�a ..�,�, , �.s������: , .�� . .� , �..�;�,-. ��3;�cY�. ,» . . ,. �.�-,�.�, <br /> Job Address Lot # ' � <br /> Sub Division Parcel # <br /> �. � w .��w,nr.:.a,�„�•x- - - " - - � _ - .�::x'n»�rsL,.ax�4«u�-,y^,.�s.�a.rtr.--^-:sr �. _ ���r, _ , _ _ , . _,w;z�astn�:o�^r••�::.:t>a:ss� <br /> � Bio-Hazard Waste Storage - ANNUAI � Fumigation Tent <br /> a Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facilitya-NdaF1UAL <br /> � Controlled Burn � Hood Installation �' <br /> � Emergency Generator < 30 kw � LPlNatural Gas-Installation ��� �j <br /> � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL S e / <br /> Fire Protection Maintenance - ANNUAL a Places of Assembly-ANNU ` <br /> � � o� ' <br /> emi n er <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 RoofinglTar 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 /> � ,�. ..�°�*.:��.au.;a�,>,: �r. x .a���s,���c�-;�.�r--^ . . ,.:.a�� <br /> Contractor Company �' • � r - <br /> Signature Registered Y/ N e Current Y/ N <br /> Address M � �a License # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> PLUMBER Company <br /> Signature Registered Y/ N Fce Curre�t Y/ N <br /> Address License # <br /> MECHANICAL Company <br /> Sig�ature Registered Y/ N Fee Curtent Y/ N <br /> Address License # <br /> OTHER Company <br /> Signature Registered Y/ N Fee CuRent Y/ N <br /> Address License # <br /> e <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:l/appraiser.pascogov.com) <br />